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UNITED STATES OF AMERICA. 



Pruritic R hinitis 

or 

Pruritus Rhinitis Catarrhus. 



PRURITIC RHINITIS, 



(Hay-Fever, Autumnal Catarrh, etc) 



ITS 



EDICAL AND OURGICAL 



Si 



Treatment ; 



WITH EIGHT ILLUSTRATIONS. 

THOS, F, RUMBOLD, M, D„ 

Fellow of the American Rhinological Association ; Member of the St. Louis 
Medical Society ; Permanent Member of the American Medical Asso- 
ciation, and of the Missouri State Medical Association, etc. 




ST. LOUIS: 

MEDICAL, JOURNAL PUBLISHING COMPANY. 

2 6 2 2 Washington Avenue. 

1885- 







COPYBIGHT BY 

THOS. F. RUMBOLD, 

ST. LOUTS, MO. 

1885- 



This little Monograph is Respectfully 

Inscribed 

to THE 

FELLOWS OF THE AMERICAN RHINOLOGICAL ASSOCIATION. 



ILLUSTRATIONS. 



Fig. 1. Tongue Depressor. - - - 110 

Fig. 2. Spray Producers. - - - - 110 

Fig. 3- Antero-Posterior Section of the Head show- 
ing the combined direction of Spray Producers 
]STos. 2, 3, 4 and 5 in the local treatment of the 
pharyngo-nasal cavities. - - - 111 

Fig. 4. Anterior Nasal Mirrors. - - 129 

Fig. 5. Pharyngeal Mirror. - - - 133 

Fig. 6. Soft Palate Eetractor. - - 134 

Figs. 7 and 8. Dr. Stucky's Applicators. 155 & 156. 



PREFACE. 

The subject of this little monograph is not new, 
yet but comparatively little has been written on it 
until the last two or three years. Within this short 
period, rapid progress has been made in the methods 
of treatment. The experience of the last two or 
three years especially, has abundantly proven that 
what was at one time considered as an irremedia- 
ble complaint is now under complete control. The 
methods of investigation former^ employed were 
barren of results, with the exception of demonstrat- 
ing that the names given to the ailment were mis- 
leading and not descriptive as they purport. 

The name I have suggested, Pruritic Ehinitis 
or Pruritus Ehinitis Catarrhus or Pruritic Ca- 
tarrh, is descriptive of its most prominent and con- 
stant characteristics, namely, itching, inflammation 
and flow of mucus. 

I have no doubt the profession will observe — 
as soon as their attention is called to it — a sufficient 
number of facts to convince them that this complaint 



x Preface. 

LS ONE OF THE VERY MANY SEQUENCES OF COMMON NASAL 

catarrh. This I said in a paper read before the St. 
Louis Medical Society in May, 1869. I made the 
same statement during a discussion on so-called hay- 
fever at the Illinois State Medical Society, at its 
meeting in Jacksonville, III., in May, 1874. On page 
60 of my work on Hygiene and Treatment of 
Chronic Nasal Catarrh, is seen the same asser- 
tion. Although this work was not given as a whole, 
to the public, until Januaiy, 1831, } T et I gave a few 
forms (about 166 pages), in which this statement occurs, 
to quite a number of the members of the American 
Laryngological Association in June, 1880, and sent 
out several hundred copies of the same pages to phy- 
sicians in the West, as an advertisement of my book. 
The first rational step toward the cure of this 
complaint, is its treatment as a sequence of chronic 
inflammation of the nasal passages. Unless such a 
course ispersued successfully, even the results of a 
radical surgical procedure will only be temporary, in 
alleviating the pruritic symptoms. The removal 
of a hypera3sthetic membrane can not arrest the in- 
flammatory process that was the producing cause of 
the hyperesthesia ; this is self-evident, consequently 
the ultimate recovery of the patient will certainly 
depend upon hygienic and constitutional measures 
and the spray producers. I am very sure that the 
profession will arrive at this conclusion, after they 
have had a few additional years experience with this 
peculiar complaint. 



Preface. xi 

The manuscript of this little book has been on my 
table for several years. The reason for the delay in 
its publication, was owing to the fact that within a 
few years, a surgical operation was proposed for the 
immediate relief of the most prominent symptoms of 
this complaint, and I desired to test whether the 
claims of its efficacy were well founded. 

These claims were put forth by Dr. Wm. H. Daly 
of Pittsburgh, Pa., and Dr. J. O. Eoe, of Rochester, 
]ST. Y., who, I believe, were the first to demonstrate 
to the profession the very great value of this proced- 
ure. A part of their views and experience is given 
in an appendix, with their knowledge and consent. 
In this appendix I have also given the views and 
experience of Dr. P. W. Logan of Knoxville Tenn., 
and Dr. J. A. Stuck}' of Lexington, Ky. I was com- 
pelled to present their valuable contributions in this 
form, as the part of my book containing these sub- 
jects had been electrotyped before their papers were 
received. 

While freely acknowledging that surgical interfer- 
ence will cut short the pruritic nasal symptoms, yet, 
I as freely say, I fear many patients will be operat- 
ed upon, who ought to be cured without the forma- 
tion of cicatricial tissue in the nasal passages, by 
being treated for the originating disease, the chronic 
catarrhal inflammation of the nasal cavities. That 
this latter course is successful, I know from experi- 
ence. 

Thos. F. Rumbold. 
St. Louis, June, 1885. 



CONTENTS. 



Preface -- - - ix. 

CHAPTER I. 

INTRODUCTION. 

Only Lately Attracting the Attention of the Pro- 
fession.— Usual methods of investigation defetive. 
The inflammation that prepares the patient's nasal 
passages for this complaint causes no pain. - 17, 21. 

CHAPTER II. 

Pruritus Rhinitis Catarrhus ;— or Pruritic Rhinitis ; 
or Pruritic Catarrh ; or Itching Nasal Catarrh, (Hay- 
Fever, Rose-Cold, June-Cold, July-Cold, Polle?i-Feve?\ 
Autumnal Catarrh, Ragweed-Fever, Peach-Cold, Slim- 
mer Catarrh, etc). The present names inappropriate : 
a new name suggested; table of dates of attack ; table 
of dates of disappearance. - 22,31. 

CHAPTER III. 

History of the Literature of Pruritic Rhinitis. 32, 40. 

CHAPTER IV. 

Pruritus Rhinitis Catarrhus (Hay-Fever, Summer Ca- 
tarrh, Autumnal Catarrh, etc,) — One of the Sequences 



xiv Contents. 

of Chronic Catarrhal Inflammation of the Nasal Cavi- 
ties. Statements taken from the early histories of 
patients suffering from pruritic rhinitis, or itching 
nasal catarrh, to prove that it is a sequence of 
chronic catarrhal inflammation of the nasal passa- 
ges. - 41, 63 

CHAPTER V. 

Local Symptoms; Subjective and Objective. — The 
skin ; the eyes ; the nasal cavities ; the pharyngo-nasul 
cavity ; velum and uvula ; Eustachian tubes and mid- 
dle ears ; fauces and larynx ; the tonsils ; the trachea ; 
bronchial tubes and lungs ; deceptive sensations ; the 
voice ; asthmatics ; the heart. - 04, 74. 

CHAPTER VI. 
Constitutional Symptoms. 75,77. 

CHAPTER VII. 

Course of Pruritic Rhinitis. — Stage of non-recogni- 
tion ; pruritic catarrh, or the early form known as 
rose-cold or June-cold ; the attacks that occur in 
July ; the attacks that occur in autumn. - 78, 91. 

CHAPTER VIII. 

Influence of Location.— For very chronic cases ; ocean 
travel ; westward ; lake superior ; a tour on the con- 
tinent. - 92, 96. 

CHAPTER IX. 

Causes of the Paroxysms. — Dust; bright sunlight; ex- 
haustion from heat. ----- 97, 99. 

CHAPTER X. 

Diagnosis and Prognosis.— The first or formative stage ; 
differential diagnosis of the various stages of pruri- 
tic rhinitis (a table) ; the second or the May or June 
£ rms ; the third stage or the July form ; the fourth 
stage or the autumnal form ; the prognosis. 100, 107, 



Contents. xv 

CHAPTER XI. 

Treatment ; Medical and Surgical. —Alleviative treat- 
ment ; local applications ; tongue depressor ; spray- 
producers ; prescription of vaseline comp : section of 
the head showing- the combined direction of sp: ay- 
producers Nos. 2. 3. 4. and 5 in the local treatment 
of the pharyngo-nasal and nasal cavities; prescription 
of pinu* canadensis comp. electricity ; constitutional 
treatment; special hygiene of pruritic catarrh {hay- 
fever) ; protecting the head; the hair: wigs healthful 
to the bald-headed ;hats and caps : clothing; inunc- 
tion of the body ; the feet ; the sleeping room ; sleep ; 
the diet ; exercise ; to be avoided. 

Surgical Treatment.— Remarks in favor of conservative 
surgery ; important facts ; the kind of cases to be 
operated upon ; relief by surgical measures ; locating 
the diseased membrane ; anterior nasal mirrors ; ap- 
plication of the galvano-eauu ry : Jarvis's snare ; 
chromic acid ; nitric acid ; posterior nares ; pharyn- 
geal mirror ; soft -palate retractor. - - 108, 134. 

APPENDIX. 

Extracts from Dr. Wm. H. Daly's Article. - 135. 137. 

Extracts from Dr. J. O. Hoe's Paper. - - 138,141. 

Pruritic Rhinitis ; by Dr. P. \V. Logan ; President of the 
American Rhinological Association, etc. Ii2, 145. 

Pruritic Catarrh, or Hay-Fever, its Treatment ; by Dr. 
J. A. Stucky; Surgeon to Joseph's Hospital ; Mem- 
ber of the Kentucky State Medical Society ; Vice 
President of the American Rhinological Associa- 
tion, etc. - 146, 159. 

Index. ------- - 161. 167. 



PRURITUS RHINITIS CATARRHUS; 
( Hay- Fever, Summer Catarrh, 

A l T IT M N AL C A T A R II, i. TC . ) 

CHAPTER I. 

INTRODUCTION. 

Only Lately Attracting the Attention of 
the Profession. 

This complaint, popularly known as "hay-fever", 
"rose-fever," "June cold," "Autumnal -catarrh",etc, has 
only of late years attracted the attention of the medical 
profession. I have not the least hesitancy in saying that 
this is due to the fact that they have only of late found 
the department of Ehinology one of interest, or rather 
one of more importance than was accredited to it a 
few years ago. 

It is a malady that has several peculiar characteris- 
tics, among which may be named: its re-occurring, 
almost uniformly at certain seasons of the year and 
affecting its victims to the severest degree in certain 
regions of the country, while at other seasons and in 
other regions, the great majority enjoy almost com- 
plete exemption from its attacks, It has another dis- 
agreeable peculiarity, namely, it has not until very 
lately been relieved by any methods of medical treat- 



18 Constitution of the United States 

merit. Indeed so eompletjy have the profession failed 
to even ameliorate the complaint, that the victims have 
given up all hope from this quarter and in 1874 formed 
themselves into a society solely for the purpose of 
mutually search ing for relief. They have agreed to re- 
port at any time "during their natural life and after- 
ward if permitted" any remedy for their ailment. Up 
to last September no such remedy has been reported 
by their secretary. Such extraordinary measures 
were never before taken by any class of invalids. 

As a matter of interest I will give their constitution 
in full: 

"Article, I. This organization shall be called 'The 
United States Hay-Fever Association/ 

"Article, II. Its object shall be mutual benefit, and 
seeking for information which shall serve to releive 
ail sufferers with hay -fever, wherever found. 

"Articlf, III. Any person afflicted with hay- 
fever or rose-cold may become a member of this as- 
sociation by signing the constitution. 

"Article, IY. The ofiicers of this association shall 
consist of a president, vice-presidents, an advisory 
board, a treasurer, corresponding secretary, and re- 
cording secretary. 

"Article, Y. It shall be the duty of each member 
to report to the recording secretary the discovery of 
any remedy, source of relief, or exempt district which 
may come to his or her knowledge during their natur- 
ral life, and afterward, if permitted. 

"Article, YI. The secretary, on receipt of such 



Hay- Fever Association. 19 

information, shall apprise each member of the associ- 
ation at their last and usual place of abode. 

"Article, VII. Honorary members may be elec- 
ted at any meeting of the association. 

"Article, VIII. The annual meeting of the asso- 
ciation for the choice of officers and other business 
shall be held at Bethlehem, N. H. on the last Monday in 
August in each year, at 4 P. M. Other meetings may 
be held September, upon the call of any six members 
of the board of government. 

'"Article, IX. This constitution may be amended 
at any annual meeting by vote of the majority pres- 
ent." 

The formation of this organization proves that the 
despair of e^er receiving relief from the medical pro- 
fession must have been great indeed, and it is a stand- 
ing condemnation of that profession. Evidently this 
medical inability — to give it no harsher name — is 
due to the fact that they have heretofore wholly ig- 
nored the study of the diseases affecting the nasal pas- 
sages and the cavities connected with them. 

Until a systematic course of study of this region 
is pursued and equally systematic investigations are 
made by a large number of the profession, the success- 
ful treatment of all the ailments sequent to catarrhal 
disease of the nasal cavities will not be made known. 

USUAL METHODS OP INVESTIGATION DEFECTIVE. 

The methods of investigation usually persued by 
those who have devoted some time to the study of 



20 Defective Methods 

this complaint have been to receive from the sufferers 
their own account of their symptoms or condition, in- 
stead of endeavoring to ascertain the causes that pre- 
pared the victims mucous membrane for the attack. 

The answers received related to the dates of the 
attack and disappearance, and a number of other pec- 
uliarities, all of which did more to confuse and mystify 
than to elucidate the subject. 

The investigators have thus laid themselves liable 
to be led as far astray by these histories, as they would 
be from the answer of an individual who had a disease, 
the existence of which he had no sensible knowledge; 
for instance: the answers of one afflicted with a mon- 
omania, if questioned on the subject of his mental ail- 
ment. On all other subjects he could, in all probabil- 
ity give correct answers. So with the sufferers of this 
complaint; on many other matters connected with 
their disease, except as to the condition of their mu- 
cous membrane, they could give correct answers, but 
on this subject they are very liable to give incorrect 
answer, simply because there are no subjective symp- 
toms connected with this peculiar conditon of their 
nasal passages, and these are the only symptioms 
they could give. 

THE INFLAMMATION THAT PREPARES THE PA- 
TIENTS NASAL PASSAGES FOR THIS COM- 
PLAINT CAUSES NO PAIN. 

It is because of the non-subjective character of prolif- 
erative inflammation, that a large per centage of these 



Of Investigation. 21 

sufferers state positively that they were in a perfect- 
ly healthy condition up to the period of their first 
attack and between their attacks. This shows the 
fallacy of allowing the victims to write the histor- 
ies of their own complaint, especially when the dis- 
ease is to be studied from these histories. 

This subject will receive further consideration in 
another portion of this work, but enough has been 
given to show plainly that this method of investiga- 
tion is exceedingly liable to be misleading. 

I have purposely abstained from considering purely 
theoretical points, such as accounting for the attacks 
so frequently occurring in summer and in certain re- 
gions of the country, while during cold weather and 
in a few parts of the country the victims enjoy com- 
parative exemption. 

These and other apparently inexplicable features 
of this neurotic rhinitis, may ultimately assist in the 
further elucidation of its etiology, which at the pres- 
ent writing is considered unknown. 



CHAPTER II. 



Pruritus Rhinitis Catarrhus ; or Pruritic Bhini- 
tis; or Pruritic Catarrh ; or Itching Nasal 
Catarrh, ( Kay-Fever, Hose-Cold, June-Cold, 
July Cold, Pollen-Fever, Autumnal- Catarrh, 
Ragweed-Fever, Peach- Cold, Summer- 
Catarrh, etc.)* 

THE PRESENT NAMES INAPPROPRIATE J A NEW NAME 
SUGGESTED. 

All the names by which this peculiarly phenom- 
enal complaint is known are inappropriate and mis- 
leading. 

As the medical profession should not agree to a 
change of a name of a disease without good and 
sufficient reason, I ask a part of your valuable 
time, while I endeavor to show from the character- 
istic symptoms of the complaint that the names given 
are misleading, that we have a more appropriate 
name in Pruritus Ehinitis Catarrhus, or Pruri- 
tic Catarrh, because the prominent symptom of this 
kind of nasal catarrh is an itching. 

It is noticeable that in giving names to diseases, it 
is oftentimes designed to indicate their nature, byse- 



* Head before the St. Louis Medical Society, May 3rd, 
18S4. 



Present Xa:.ies Misleading. 23 

lecting some prominent symptom or peculiarity of 
the complaint by which to designate it. When such 
names are sufficiently descriptive, we may not do 
better than to name a disease in this way. Thus, 
some names point to the part of the body affected, as 
cerebrospinal meningitis, pneumonitis, rhinitis, laryn- 
gitis, otitis, etc: some, the appearance of the patient 
while sick, as yellow fever, scarlet fever, spotted fever, 
some, the supposed cause of the ailment, as mala- 
rial fever, bilious fever, hay-fever; and still others, the 
time of the year in which attacks occurs, as summer 
catarrh, autumnal fever etc. If all of such names 
truly indicated what they seem to do, then they might 
very properly be retained, but if any of them indicate 
that a certain prominent fact or feature of a disease 
is constantly present, so as to distinguish it from 
other diseases, when such is not the case, then, most 
certainly, the misguiding name should be discarded; 
as its retention will be very liable to lead to an erron- 
eous diagnosis, and thus a case might be excluded 
from its proper class and, as a consequence, be im- 
properly treated. 

Recent investigations, of a very thorough charac- 
ter, go to prove that the various names by "which 
this complaint is designated, are misleading. I am 
not unmindful of the fact that Dr. Morrill Wyman, a 
high authority on this complaint, regards the spring 
and fall forms as separate diseases. In this, I think 
that he is mistaken. On this point I agree with Dr. 
G. M. Beard, also an excellent authority on u bayv 



24 Identity of Spring and Fall Forms. 

fever." Dr. Beard says : " In view of the large num- 
ber of facts afterward obtained, and which are re- 
corded in this work, it was found necessary to aban- 
don this theory [ the two forms of the complaint ] 
and to admit the substantial identity of ' Autumnal 
Catarrh' and 'June Cold'." If the dates of attack 
and disappearance were erased from the history of a 
case of this disease, I defy, even an expert, to do 
better than guess the season of the year in which it 
occurred, nor could he make a better gues3 as to the 
duration of the attack. I am unable, after a very 
careful study of Dr. Wyman's really valuable work, 
to perceive the difference between the spring and 
fall forms of the complaint, except one of severity 
and that they almost uniformly occur, the one in the 
spring and the other in the fall ; but the individuals 
who have the attack uniformly in May or in June 
or in July, relate, identically, the same symptoms as do 
those whose date of attack occurs in August or Sep- 
tember, the fall form being the more severe. All 
kinds of this class of sufferers are exempt from attack 
by resorting to the same mountainous regions of the 
country and, according to my experience, all are re- 
lieved by the same kind of hygienic management and 
the same kind of constitutional and local treatment. 
Cases are not at all uncommon who may, for a few 
years, be afflicted in the early summer months but, 
from some unknown cause, pass the usual period of 
attack, and experience it either later or earlier than 
usual. I have a young patient under treatment now, 



HAY 18 NOT ALONE THE CAUSE OF ATTACKS. 25 

whose first attack occurred in July, the next in May 
and the next in September. 

That others consider the name not the most suita- 
ble, is seen from the following quotation taken from 
Dr. Beard's work. lie says : 

" The inappropriateness or rather the insufficiency 
of the term hay-fever is now quite generally admitted; 
for even where the predisposition exists, hay of any 
kind, fresh or dried, acts as an exciting cause in but a 
minority of cases, and rarely, if ever, is it the only 
irritant that gives rise to the paroxysms." 

The name "hay-fever" indicates that hay alone 
is the cause of the attack, which is very far from be- 
ing the case. I have a patient who can handle hay 
at any period of the year without experiencing the 
least inconvenience, another one who is not the least 
affected by it, so long as his scalp and face are not 
moist with perspiration, labile this patient is per- 
spiring during warm months, any kind of dust, but 
especially that from an old carpet, instantly sets him 
wild with an itching sensation of the face and eyes, 
soon followed by the same sensation in the nostrils 
and by sneezing. 

The same objection exists with respect to the names 
"rose-cold," "pollen-fever," etc. It is almost univer- 
sally admitted that any one kind of pollen, or any 
one kind of flower, may seriously affect some persons, 
and have no bad effects on others, yet the distin- 
guishing phenomena, namely the itching, flow of 
tears, the flow of watery secretion from the nostrils 



26 Seasons of the Year are 

are nearly alike in all patients, whether they are 
attacked in the spring, summer, fall or winter. If 
they differ, it is in degree of severity only. 

This brings us to the names which designate the 
seasons of the year in v/hich the disease occurs. If 
the seizures uniformly commenced in June, July or 
during the autumnal months, the name of the month 
or of the season of the year might very properly be 
prefixed to the word "cold" or "catarrh" or "fever" 
or "asthma," but my observations since 1862, and the 
very thorough investigations of Dr, Beard, leave no 
doubt that the attacks may occur in any month dur- 
ing the summer. Because of its so frequent appear- 
ance daring the summer months, Dr, John Bostock, 
of London, [1819] suggested the name "Catarrhus 
Aestivus" or "Summer Catarrh." This also is mis- 
leading, as well as Dr. M. Wyman's name, "Catarrhus- 
Autumnal is" or "Autumnal Catarrh." These names 
indicate that individuals could not be attacked during 
cold weather; but it is well known that the complaint 
may sometimes affect it victims as late as October, 
November, December and even January, according 
to Dr. Beard's report. I had a patient who had at- 
tacks in every month from April to November, and 
I have one now (May, 1884) under treatment who has 
had attacks for two years; and the whole year around 
whenever he is where the air is hot and dusty. (I 
have three patients now under treatment who have 
had severe attacks in the last week in January, 1885.) 

It does not detract from the value of these facts, 



Inappropriate Names. 



27 



to Bay that these last patients and all other like pa- 
tients who have been under my care, had their 
winter attacks much less severely than their warm 
weather attacks, nor is the argument weakened by 
the fact that the very great majority of attacks of 
this complaint occur in warm weather. As the very 
sane symptoms occur in cold weather, warm-weather 
names are misleading. 

The following tables will give, in a condensed 
form, the dates of attack and of disappearance, These 
tables, which are taken from Dr. Beard's valuable 
work, do not show the duration of the attack. He 
received his information from answers to inquiries 
sent to individuals afflicted with this complaint, num- 
bering 200. 



TABLE OF DATES OF ATTACK. 



roi 


q May ltolO, 


2. 


li 


" 10 to 31, 


6, 


IS 


June 1 to 10, 


11. 


l< 


11 10 to 80, 


8. 


K 


July 1 to 10, 


6. 


u 


44 10 to 20, 


6. 


u 


46 20 to 81, 


7. 



From Aug. 1 to 10, 7. 
" 10 to 20, 81. 
44 20 to 31, 54. 
Sept. ltolO, 7. 
44 10 to 20, 1. 
44 20 to 30, 2. 
June to Sept, 1. 
Aug. to Jan. 1. 



As to dates of disappearance the answers recci 



were the following 



TABLE OF DATES OF DISAPPEARANCE. 

January or early winter. 2 

About January 1st. - - - - - 1 

Late in winter. ------] 

March 1st. - 1 

Middle of July. ------ c 

Latter part of July. . - - - - - 5 



28 Vegetable or Parasitic 

Early in August. ----- 5. 

Middle of August, ----- 2, 

Latter part of August. 1. 

Early in September. ----- 2. 
Middle of September. 13. 

Latter part of September. - 26. 

Early in October. ----- 42. 
Middle part of October. - - - -14. 
Latter part of October. - 3. 

Early in November. - - - - - 9. 
Middle of Kovember. 4. 

Early in December. - - - - - 1. 
Middle of December. - - - - 1. 

From September 15 to December 25. - - 1. 
With frost or cold weather. - - - S5. 
Three weeks after beginning. - - 1. 

Cannot state definitely. - - - - I . 

It is self-evident, from the facts shown by these 
■tables, that "Kose-Cold," "June-Cold," "Hay-Fever," 
"July-Cold," " Pollen-Fever " " Summer-Catarrh," 
" Autumnal-Catarrh," are all inappropriate, or rather 
insufficient names, and that any one of them tends to 
mislead the physician who would allow himself to be 
guided by the characteristic suggested by the name. 

A strong point in favor of the parasitic or vegetable 
theory is made in the constancy and regularity of the 
appearance of the disease at given times with some 
of the victims, not only coming on at a fixed day, but 
the very hour, and also its almost regular disappear- 
ance at such times as might usually be expected that 
the spores of the bacteria or vegetable growths 
would be destroyed by natural causes. If this nasal 
trouble is caused by germs, why may not other nasal 
troubles originate from germs ? Without answering 
this question I will ask another : How could germs 



Theory not Tenable. 29 

cause this trouble when they depend upon a peculiar 
condition of the fluids of the mucous membrane for 
sustenance, which condition must have been the re- 
sult of diseased action ? As these germs do not in 
this way affect a healthy mucous membrane, does 
this not show that diseased action was primary, and 
germ irritation secondary? Dr. Beard while speak- 
ing on the vegetable theory, says : " This suggests 
to almost any one the possibility that some parasitic 
or vegetable emanation appearing only during the 
season of the disease might be the cause. 

"If it could be shown that some at least of the 
symptoms were felt at other than these so-called ca- 
tarrhal seasons; if sufficient evidence of the occur- 
rence of certain phases of the malady in the winter 
and spring could be obtained, the parasitic and vege- 
table theories would be seriously shaken. 

"This evidence is here given. The hay-fever symp- 
toms that are in the winter excited by exposure to 
the dust of hay or of the house, or to animal emana- 
tions, are usually, if not always, of a transient char- 
acter, lasting but a few minutes or hours ; but for 
this brief time they are characteristic of the disease, 
and they do not appear in other persons." 

He arrives at these conculsions from answers to the 
following question: "Do you ever have, during the 
winter or spring, when exposed to any of the excit- 
ing causes, as dust etc., attacks resembling ' hay-fever' 
in a mild form, lasting perhaps for a few minutes or 
hours V 



30 A Name that is Descriptive of its 

Of 200 affected individuals, 101 answered Yes, 77, 
"No. His special replies to the same question, contain 
these significant expressions: "Lots of e'm, hut mild 
in form/* 7 "For a few hours/' "Dust of hay will cause 
it." "Caused by dust," "Dust of sweeping, etc/' 

Pruritus Ehinitis Cata rrhus, or Pruritic Ehin- 
itis, or Pruritic Nasal Catarrh, or Itching Nasal Ca- 
tarrh, is the name that I have selected for this phe- 
nomenal complaint. This name is descriptive of its 
most prominent and constant characteristics, namely 
itching, inflammation and flow of mucus. 

The attack is ushered in by an itching of the ncse 
and face; this soon affects the eyes, causing intense 
suffering. The itching sensation in the nostrils 
gives rise to prolonged sneezing ; this, in turn, make3 
the eyes still worse; presently, the itching reaches 
the soft palate and the fauces, and to relieve these 
parts of this same sensation, the tongue is used 
to rub them. As the tickling is not relieved a rasp- 
ing cough is tried, which is so persistently continued 
that the throat soon becomes sore, and in older suf- 
ferers, shortness of breath ensues, and symptoms of 
asthma are developed. I have not had a patient that 
did not experience this itching early in the disease, 
and it was always prominent. Dr. Beard, gives this 
as the first symptom and says of it, on page 113, 
" This is one of the first, oftentimes the very first 
local symptom of an attack.*'" Dr. Wynian, in his 
work on "Autumnal Catarrh*' in mentioning the local 
symptoms as they occur consecutively, says, on page 



most Prominent Symptom Proposed. 31 

12. "The lining membrane of the nostrils is the part 
first affected : beginning with a slight tickling or itch- 
ing, which soon shoots upwards towards the eyes, and 
even into them." 

To repeat, because of the uniformity of this symp- 
tom, and the fact that it is always accompanied by 
inflammation, I think the name Pruritus Rhinitis 
Catarrhus or Pruritic Rhinitis or Pruritic Nasal 
Catarrh or Itching Nasal Catarrh i< more descriptive of 
the complaint than any of the names new given to it. 
This name indicates the first, the principal and the 
most prominent symptom and which is truly charac- 
istic of the malady at whatever season of the year 
the victim is attacked, and it is not misleading. 



CHAPTER III, 



History of the Literature op Pruritic Ehinitis. 

Little or no benefit is to be derived from the study 
of the history of the literature of this complaint. For 
this reason, only the outline will be given, and that 
as conscisely as possible. 

In 1819 Dr. John Bostock of London presented a 
paper to the London Medico-Chirurgical Society, in 
which he gave the first formal description of this 
complaint, describing his own case. The title of his 
paper was a "Case of a Periodical Affection of the 
Eyes and Chest." This paper was published in the 
Medico-Chirurgical Transactions, page 161, part 1. 
volume x. In 182-1 he gave the complaint the name 
of " Hay-Fever". 

In 1828 the same author read another paper on the 
Fame subject and gave the disease the name of Catarr- 
hus iSstivus or Summer Catarrh. This also was pub- 
lished in the same Transactions, Volume xn, page 437. 
This name is still retained by many writers. 

In this year (1828), Dr. Mac Culloch published 
" An Essay on Eemittent and Intermittent Diseases ". 
In this he mentions a complaint that he thought was 
caused by emanations from hot-houses and green- 



From 1829 to 1850. 33 

houses, but especially from hay-fields. He says that 
the "common people observed that the disease was 
brought on by exposure during hay-making seasons." 

In 1829 Mr. W. Gordon published a paper in the 
London Medical Gazette, Volume iv, page 266, on the 
" Observations on the Nature, Cause and Treatment 
of Hay- Asthma". He thought that the flowers of grass 
was the cause. For this reason he thought the com- 
plaint should be called " grass-asthma n instead of 
" hay-asthma". 

In 1830 "Mr. A. Praster published the history of a 
case. 

In 1831 and in 1833 Dr. Elliotson referred to a com- 
plaint resembling this one, and published it in the 
London Medical Gazette. He rejects the heat theory of 
Dr. John Bostock, and the hay theory also, and 
amrms that grass and probably the pollen of flowers 
are the causes. 

In 1847 Dr. Ramadge, in his work on " Asthma/*' 
published in London, holds that the emanations of 
of grass and flowers give rise to attacks of this dis- 
ease, 

In 1850 Dr. Gream published a paper in the Lon- 
don Lancet, Tolume i. page 692, on the " Use of Nux 
Vomica as a Hemedy in Hay-Fever." In this paper 
he afiirms that neither the flowers of grasses or any 
other flowers are the producing causes, but that it is 
in-door and out-door dust that are the exciting causes. 
He observed that after a rain the victims were much 
relieved. 



34 From 1852 to 1856. 

In 1852 Dr. La Forgue of Toulouse, wrote a paper 
on this complaint. He advocated the heat theory. 

In 1854 Dr. Morrell Wyman of Cambridge. Mass. 
being himself a sufferer of what he terms " Autumnal 
Catarrh," discribed the complaint in his course of lec- 
tures in the Medical School of Harvard University. 
He says " the description was drawn from my per- 
sonal experience, and a few cases which had come 
under my observation for treatment." 

In 1857 Dr. Watson says that this malady is caused 
by vegetable emanations floating in the air. 

In 1859 Dr. Walsh in his " Treatise on the Diseases 
of the Lungs," refers to this complaint and calls it a 
singular variety of " naso-pulmonary catarrh." He 
says that the complaint occurs daring hay-making 
time and that the odor from this and from grasses are 
the causes, but he states that he has the history of a 
well attested case in which the victim suffered from 
an attack while on a voyage across the Atlantic. 
Each day's symptoms were given. 

In this year (1859), Dr. H. Salter, the asthmatic 
author of a work on u Asthma " states the complaint 
is a hay-asthma and lasts during the hay-making sea- 
son, and adds, that heat, dust and sun shine are the 
agencies that most frequently excite an attack. 

Dr. Philip Phoebus, a professor in the University 
of Giessen wrote in this year also, far out stripping 
his predecessors in thethoroughness of his investiga- 
fions. 

From extensive correspondence, which was exten- 



From 1860 to 1866. 35 

ded almost through the entire civilized world, he 
gathered many facts not before known. But he was 
not satisfied with his conclusions as to the etiology of 
the complaint ) he says that it will require more ac- 
curate observation to come to positive conclusions. 
He thought that odors of flowers, probably that of 
rye was the most irritating, and the irritation of dust 
assisted by long heat and ozone were the causes of the 
attacks. His investigations were published in 1862. 

In 1860 Dr. Koranz of Neufchatel, Switzerland, 
wrote a paper on " Hay-Fever," and published it in 
the Le' Echo Medical. He thought that the flowers 
of grass was the irritating cause. 

In May 1866 the facts known to Dr. Morrell Wyman 
were embodied in a paper read at the Annual meeting 
of the Massachusetts Medical Society in Boston. The 
following abstract was published in the Boston Jour- 
nal June 2nd, 1866. 

"Autumnal Catarrh : At a meeting of the Massa- 
chusetts Medical Society, Dr. Wyman of Cambridge 
gave an account of a singular catarrhal affection, or 
cold, hitherto undescribed, and named by him Autum- 
nal Catarrh. There are two annually appearing 
catarrhs in this country : the summer catarrh (com- 
monly called Eose Cold, Hay Fever or June Cold) 
begins the last week in May or the first week in June, 
and lasts four or five weeks; the other, the Autumnal 
Catarrh, commences the last week in August, and con- 
tinues till the last week in September. It begins with 
sneezing, itching of the eyes, especially at the inner 
corners, watering of the eyes, and a profuse discharge 



36 Dr. Wyman's Paper. 

from the nostrils. The affection of the eyes is in fits, 
coming on suddenly, compelling the sufferer to rub 
his eyes violently for relief. The fits of sneezing and 
nose-blowing and obstruction of the nostrils are also 
sudden, and when the fits are over, usually in a few min- 
utes, go off as quick as they come. During the second 
week in September, a cough sets in, dry, violent, and 
in fits; it is increased during dry, dusty weather, and 
relieved by an easterly storm. It is severe in the 
night, and there is sometimes asthma. The disease 
subsides during the third week in September, and by 
the first of October, or the first good frost, is entirely 
gone. It is not an uncommon disease; Daniel Webes- 
ter had it annually for twenty years, and while Secre- 
tary of State suggested to President Fillmore the pro- 
priety of resigning on account of it. The late Chief 
Justice Shaw of Massachusetts was another victim. 
Medicines seem to have been most freely tried with- 
out materially relieving its severity or shortening its 
duration. Fortunately, it has been ascertained that 
there is a most complete and agreeable cure.* Within 
twenty-four hours after the sufferer arrives at the 
White Mountains, at G-orharn, at the Glen House, or 
the Waumbec, it suddenly disappears and if he re- 
mains till the last week in September, the usual time 
of disappearance, does not return for that year. The 



* I am astonished that such an accurate man as Dr. Wy- 
man, should employ the word " cure " in this sentence, when 
he means complete cessation of the symptoms during that 
catarrhal season, on condition that the victim remains in the 
locality named. Cure, means complete, continuous recovery 
without recurrence at any season, complete return to 
health. He does not desire that this should be inferred. 



From 1866 to 1867. 37 

relief at Franconia is not so certain as at the north 
side of the mountains, though most are relieved there 
also." 

In this year (1866) Dr. W. A. Smith also published 
a work " on Hay-Fever, Hay- Asthma or Summer 
Catarrh." He thought the worst symptoms were 
brought on by great heat, grass and flowers. With 
great fairness he gives the history of a patient that 
jjroves that his views are not invariably correct; 
namely : 

"This year the disease first came on while I was on 
the sea yachting with a friend. It was a hot day in 
May, with wind from the southwest, the nearest land 
to windward being nine miles distant. I felt myself, 
after some exertion in assisting to hoist the sails, sud- 
denly seized with sneezing, and I have had it ever 
since."* That is up to June 13th, of that year. 

In 1867 Dr. W. Pirrie of London, published a work 
on " Hay-Asthma and the affection termed Hay-Fe- 
ver." He added little to the literature of the sub- 
ject, except the very important idea that the nervous 
system was a far more important factor to the com- 
plaint than had heretofore been supposed. 

" This little treatise of Dr. Pirrie is remarkable 
that in many respects it theoretically anticipates what 
I>y these statistics and facts, has been demonstrated in 
regard to the nature of hay-fever, and the true princi- 
ples of treatment as now confirmed by a large induc- 
tion in Europe and America. The number of his facts 
was so limited, and the cases he gave were so imper- 
fectly detailed, that none of the points he suggested 

* Beard on Hay-Fever, 1876. 



38 From 1869 to 1870. 

could be considered as proved; consequently, they 
have not been generally received, and have excited 
comparatively little attention ; they were suggestions 
and nothing more, and they left the subject as mysteri- 
ous as they found it." 

"What author has not left the subject as mysterous- 
as he found it ? 

In 1869 Prof, Carl. Binz of Bonn, Germany, con- 
tributed an article to Virchow's Archives for February, 
on the use of quinine as a remedy for this complaint. 
In this article he gives a letter addressed to him from 
the iilustrous Helmholtz recommending the local ap- 
plication of the sulphate of quinine as a remedy. 

In this year (1869). in a paper read before the St. 
Louis Medical Society on the sequences of chronic 
nasal catarrh, I said that careful investigation would 
substantiate my assertion that "hay -fever" was one of 
the sequences of chronic inflammation of the mucous 
membrane of the nasal passages, giving at the same 
time the history of the symptoms and the treatment 
of the first case given in this work. In two or three 
years after this I re-asserted these views before the 
Illinois State Medical Society, at its meeting in Jack- 
sonville, on the occasion of a discussion on the effects 
of quinine when applied to the nostrils as a cure for 
hay-fever. 

In 1870 Dr. G-, Moore of London, published a work 
on "Hay-Fever or Summer Catarrh ; its Causes, Symp- 
toms, Prevention and Treatment." He favored the 
theory of sunlight, heat and the effluvia of hay and 



From 1872 to 1876. 39 

flowers as will as decomposing vegetable matter. 

la 1872 Dr. Morrell Wymau again contributed his 
experience and observations of " Autumnal Catarrh 
(Ray-Fever.)" 

" A leading thought in this work of Dr. Wyman is 
that in the United States, under the general term hay- 
fever, two distinct forms of disease are included the 
so-called 'Rose-Cold' or 'June Cold' occurring in 
May or June, and corresponding to the 'hay-fever' 
or 'hay-asthma ' of England and the continent, and a 
later form, beginning in August and lasting several 
weeks in the fall, to which he gave the name ' Autum- 
nal Catarrh.' "* 

In 1873, Mr, Chas. H. Biaeklay an eminent surgeon 
of Manchester, England published a work on " Ex- 
perimental Researches on the Cause and Nature of 
Catarrh us iEstivus (Say-Fever or Hay- Asthma)," 
He advocates that the pollen of grass is almost exclu- 
sively, the cause of the attacks of the complaint, and 
thinks that the names " Pollen-Fever" or " Pollen 
Catarrh " more appropriate. He made a large num- 
ber of experiments with the fresh and dried pollen of 
the grasses and of other plants and believes that he 
substantiated his theory. He says that rabbits, guinea- 
pigs and cats are sirailiarly affected by the pollen. 

In June 1876, the late Dr. George M. Beard pub- 
lished an excellent work on this subject, and claims to 
have discovered, what he terms a " middle form of hay- 
fever." He advocates what he calls the nerve theory, 
and, according to my views, is far in advance of all 

* Beard on Hay-Fever. 



40 1876. 

previous authors. The following quotation from the 
preface of his work, will give a partial idea of his 
views : 

"The theory of this book, that this disease is a com- 
plex resultant of a nervous system especially sensa- 
tive in this direction, acted upon by the enervating in- 
fluence of heat, and by any one or several of a large 
number of vegetable and other irritants, has the ad- 
vantage over other theories ; that it accounts for all 
the phenomena exhibited by the disease in this or in 
any other country ." 

In August of this same year we are gives a most 
carefully prepared work on fc Autumnal Catarrh (Hay- 
Eever)" with illustrative maps by Morrell Wyman, M. 
D., of Cambridge Mass. Every physician who desires 
to study this complaint should supply himself with 
this work, as well as with Dr. Beard's. 

This last Edition of Dr. Wyman contains his former 
views amplified. He holds that his Autumnal Catarrh 
is a different complaint from that of the early sum- 
mer catarrhs, i. e. the " Eose or June Cold." 

As I will take the liberty to make frequent quota- 
tions from Dr. Beard's and Dr. Wy man's valuable 
works, I will not, at present, give more of their views. 
Of course I shall differ radically from both of these 
talented gentlemen, but wish to acknowledge that I 
have received more information, in the study of this 
complaint, from their works, than from all the vari- 
ous works on this subject that has come under my 
notice which number in all about fifteen. 



CHAPTER IV. 

Pruritus Khinitis Catarrhus ( Hay-fever, Sum- 
mer Catarrh, Autumnal Catarrh, etc. ) one 

OF THE SEUQENCES OF CHRONIC CATARR- 
HAL Inflammation of the Kasal 
Cavities. * 

Authors have had a suspicion for many years, that 
this disease ("hay-fever") might, in some way, be 
connected with common nasal catarrh; consequently, 
they all have given this part of the subject some 
attention, but for various reasons they have come to 
the conclusion that there is no evidence of such rela- 
tionship. 

It seems to me that their methods of carrying 

*JRead before the St. Louis Medical Society May 10th, 1884. 



42, " Defective Methods 

on their investigations, concerning this matter, have 
not been thorough enough, and with some of the 
authors, they have been quite defective. 

They have asked sufferers, all of whom, with a 
very few exceptions, resided at a distance, questions, 
the design or tendency of which they could not 
fully understand, not being medically educated. In 
fact they have taken it for granted, that these individ- 
uals knew the cause and course of their malady, and 
the questions have been so formed, that when filled 
out they completed the histories of just such cases, 
as the victims and the authors had conceived them 
to be. 

It always requires much greater medical acumen to 
make a diagnosis, than it does to write a prescription 
for a known disease. £Tow, while no medical man 
has been known to ask an ailing individual to write 
his own prescription, yet the authors on pruritic 
catarrh have asked their correspondents to take the 
more difficult part, namely, the writing out their 
own diagnosis, and from these papers they have 
studied the complaint; and what makes these narra- 
tions of still less value, they are, almost universally 
dated from a period after their first most chracteris- 
tic attack, and not from their initiatory symptoms. 
These, the sufferei'S would not recall, unless assisted by 
interrogations conducted by one acquainted with the 
peculiarities of such cases. To say the least, this is 
a defective method, especally when there exists a- 
supposition that the complaint might be secondary to 



of Investigation. 43 

another disease. Under these circumstances, why 
not. make enquiry concerning their physicial con- 
dition previous to the first attack of pruritic rhinitis 
(hay-fever). Without this, their investigations are 
illogical, as they have left their readers ignorant of 
the condition of the system that might have made 
the attack possible, if the nasal inflammation preceded 
it or caused it. 

I am fully aware that my views on this subject are 
not in accord with any of the authorities, and in 
taking this position, it devolves upon me to prove 
that this phenomenal complaint is a sequence of 
comparatively long standing inflammation of the 
mucous membrame of the nasal cavites. This I will 
do by giving accurate and detailed histories of the 
physicial condition of those who have been my pa- 
tients, which will show that the inflammation always 
precedes it. It is evident that this will go far 

to sustain my proposition; but to make it still 
stronger, and because some might ssy that the 
co- existence of long continued inflammation in the 
nasal cavities was a co-incident and would not, of 
itself, necessarily prove that pruritic catarrh, was oc- 
casioned by it, I will give other evidences that will 
demonstrate beyond the possibility of a doubt, the 
relationship of the two complaints. This will be done 
by giving the histories of patients whose ameliorative 
treatment for chronic nasal inflammation, reduced 
the frequency and the severity of their attacks 
of pruritic catarrh and of a few other patients 



44 Chronic Inflammation 

whose treatment caused an entire cessation of the 
disorder. 

In 1869, 1 made a statment before this society, that 
a scrutinizing investigation of the patient's condition, 
during that period previous to the first attack, would 
show that chronic nasal inflammation had rendered 
them liable to be afflicted with pruritic catarrh. My 
numerous observations, made since that date confirm 
me in this matter. In fact, every individual, whether 
patient or acquaintance, that I have seen since 1862, 
who had suffered from attacks of it, had been for 
several years afflicted by chronic catarrhal inflamma- 
tion of the nasal cavities. 

I am not prepared, at present, to give my reasons 
for this neurotic form of rhinitis attacking the great 
majority of its victims in summer days and in certain 
regions of the country, while during cold weather, 
and in a few parts of the country they enjoy com- 
parative exemption. These and other apparently 
inexplicable peculiarities, may ultimately assist in 
the further elucidation of its etiology, which at 
present writing is considered unknown. Before 
giving these clinical facts, I wish to show how both 
the investigators of this complaint and the sufferers 
interrogated have made grave mistakes. 

Upon the occurrence of an inflammation of the 
mucous membrane, the blood vessels are not only 
filled to their utmost capacity, but they are greatly 
enlarged by reason of their excessive engorgement, 
being increased from 10 to 40 times their normal 



The Originating Cause. 45 

diameter, according to the severity of the irritation. 
If this inflammation should become continuous by 
repeated irritations for a number of years, the exces- 
sive amount of blood (nutrition) going to the part, 
causes its permanent thickening, just as an inflamed 
and enlarged joint will be permanently enlarged, if 
the inflammation shall be allowed to continue for a 
long time. In the case of the mucous membrane, this 
growth is denominated proliferative inflammation. 
It is during this stage of the inflammatory disease of 
the nasal passages, that the patient may, from some 
cause at present not known to the profession become 
affected with pruritic rhinitis. 

According to my observation, a most important char- 
acteristic of proliferative inflammation (and it is one 
that should be continually borne in mind), is that the 
patient does not experience the least sensation of 
pain during its progress. Xot until the caliber of 
the air spaces in the nostrils are so reduced in size, 
that respiration is thereby impeded, do they exper- 
ience the least inconvenience, except it may be that 
they have slowly, imperceptibly lost the sense of 
smell from the same cause j or, this abnormal process 
may stealthily invade the Eustachian tubes and mid- 
dle ears, and slowly and imperceptibly rob its victim 
of his hearing, but if the loss of these senses should not 
suggest the presence of this inflammatory process, he 
would be entirely unconscious of it, so perfectly pain- 
less is its growth. 

Another dangerous peculiarity of this variety of 



46 Statements op Patients. 

inflamm alion is, that the patient rarely experiences 
the usual well known symptoms of" catching cold/' 
or at least a very severe cold, yet the proliferative 
process, that is the abnormal change of the mucous 
membrane, is continuous. 

It is evident that, with this state of things, it is im- 
possible for Dr. Beard's or Dr. Wyman's correspon- 
dents, to have had the least idea that they were vic- 
tims of this variety of inflammation, the very kind, 
the only kind that could prepare their nasal mucous 
membrane for the development of neurotic symptoms. 
When these physicians did not observe this condition, 
is to be expected that the patients could have made 
mention of it when not consci ous of its existence ? 

Statements Taken from the Early Histories of 
Patients Suffering erom Pruritic Ehinitis, or 
Itching Nasal Catarrh, to Prove that it 
is a Sequence of Chronic Catarrhal 
Inflammation of the Nasal Pas- 
sages. 

x will not attempt to give lengthy details of the 
early history of each patient, nor an exhaustive state- 
ment of the symptoms when he first visited me. Of 
the early history, I will give that much only that is 
required to prove that chronic inflammation of the 
nasal passages always precedes the attack of pruritic 
rhinitis or itching nasal catarrh, and give the dates, 
treatment and the result. The plan of treatment 
will follow at another time. 



Statements or Patients. 47 

Physicians will be surprised at the uniformity wtih 
which the majority of these patients state, at their 
first visit, that they have been in usual good health 
previous to this first attack of itching catarrh, and 
also at the shortness of their memory concerning 
their symptoms for even a few days or weeks past, 
but if assisted by various questions, somewhat lead- 
ing in their character, they will be enabled to recall 
a sufficient number of incidents that make the history 
quite complete, which will be amplified by future 
conversations at subsequent visits during their treat- 
ment. 

The first case that I will report was, in this respect, 
a very decided exception as it was during my conver- 
sation with him that I was made certain that my 
views were correct concerning the relationship of this 
complaint to chronic nasal catarrh. 

Case I. Mr. Luke E. Gibson, set 43 years, a prin- 
ter, visited me on June 10th, 1867, desiring relief 
from his attacks of sneezing and asthma. These sud- 
den attacks commenced in July, 1865. The next 
commenced in July, 1866 ; on this occasion it occurred 
on a hot night about the middle of the month, imme- 
diately after he had left the printing office, between 
three and four o'clock in the morning. He thought 
the exposure to the night air was the cause of the 
attack. 

He voluntarily said that he believed that his chronic 
catarrh, which he had had since he could remem- 
ber, was "the cause of the sneezing spells." 

EARLY HISTORY. 

When a boy he had large crusts of secretion form 



48 Statements of Patients. 

in both nostrils. As he grew older these disappeared, 
but with their disappearance he began to be affected 
with severe headaches, especially over his forehead. 
Both of his ears were diseased, and he had had an 
otorrhceal discharge since his boyhood. 

His first attack of itching of his face and eyes com- 
menced one hot morning in July, 1865, as he left the 
printing office. He noticed at the same time that his 
usual catarrh had abated to a marked degree, and 
that as his sneezing grew less, which was about Sep- 
tember, his catarrh recommenced. This has always 
been the case with these two complaints. 

My attempt, at the time, to alleviate his sufferings, 
was productive of positive harm. He visited me on 
Monday, June 24, at which time the above history 
was given me. At this time I took two aural polypi 
from his left ear. 

Jan. 4th, 1868, he again visited me. His catarrh 
was very bad, and he had severe headaches. For 
this he was treated about three times a week until 
Feb* 3d, then two times each week until the 26th. 
After the treatment on this day, he had a slight attack 
of the itching of the face and eyes, but he did not 
sneeze. My treatment at this time was too irritating, 
I was applying by the spray producer a mixture of 
muriate of ammonia, tincture of iodine and tincture 
of aconite root. 

He at once went to St. Paul, where he resided 
until Sept., but was not entirely free of his tormen- 
tor. 

May 31st, 1869. Treated him two times a week, 
through June and up to July 23d; after this, about once 
a week until Aug. 21st. 

He had no attack up to this date, but sometimes ex- 
perienced sensations of the beginning of the itching 



Statements of Patients. 49 

of the eyes and edges of the alse of the nostrils. 

He passed Aug. 1870, without a recurrence of 
his pruritic rhinitis, but lived most of the time in the 
country. I have not heard of him since that date. 

Case II.— Dr. E. J. P., 50 years, Dentist of St. 
Louis, consulted me Dec. 19th, 1868, for severe frontal 
headache; for this I treated him until March 1st. Dur- 
ing his visits he informed me that he was subject to 
what he and his physician called "hay-catarrh." It 
usually attacked him in May. I recommended the 
continuation of the treatment as a preventive, To 
this he acceded. But as I was not successful in giving 
him a local treatment, without causing sneezing, he 
discontinued about the middle of May. 

His usual attack commenced this year on May SOth, 
after taking a Turkish bath on Sunday morning. For 
relief he immediately visited the mountains of Ten- 
nessee, returning to the city in the fall. 

March 1st, 1870, I commenced to give him treat- 
ment for his catarrh, this was continued for a few 
weeks, three times a week, then twice a week until 
the 14th of May, at which time he feared the itch- 
ing catarrh would attack him. 

EARLY HISTORY. 

At these visits I learned from him that he had been 
subject to sore throat, enlarged tonsils and severe 
headaches, as well as continual clearing of his throat 
in the mornings, since he was a boy. When his 
early history was first spoken of, he had forgotten all 
his early troubles about his throat and head, as these 
had not troubled him so much of late years, except on 
the occation of his visits to me. 

He started for Louisville, Ky., and arrived May 
16th, 1870, and concluded to remain there a few days 
before going to Tennessee j but this visit was pro- 



50 Statements of Patients. 

longed to the Fourth of July, at which time, as he had 
raissed his "hay-catarrh," he concluded to return to 
St. Louis. On his way home he was attacked on the 
cars. He continued on his journey home, remained 
quiet for a few days and entirely recovered. 

I gave him a few treatments in May, 1871. He re- 
mained in the city the whole of that year entirely ex- 
empt from his "hay-catarrh," I have not heard from 
him since the fall of that year. 

Case III.— Mr. J. Whaling, of Belleville, 111., set 37 
years, consulted me May 20th, 1872. 

EARLY HISTORY. 

During the last ten years has been in much better 
health than before that time. When 14 or 15 years 
of age, he had the measels, which left him with a 
severe cough and diseased ears. For many years 
after this attack of measels, he suffered from dizziness; 
would not walk down stairs without taking hold of 
the hand rail. lias had tinnitus aurium since his ears 
have been affected. 

He now has what he calls "rose-cold," and has had 
it every spring during the last three years. At first the 
attacks were not severe, always commencing in May, 
sometimes the first part and sometimes in the latter 
part of the month. This time it attacked him after 
he had taken his supper on Saturday the 18th of May. 

I treated him but two weeks with so little benefit, 
that he left me. since which time I have not heard of 
him. 

Case IY.— Mr. W. K. G-., of Memphis, Tenn., jet 
83 years, consulted me Aug. 22d, 1873 for "hay- 
fever." 

EARLY HISTORY. 

Did not remember of* being particularly liable to 
lake cold after he was 21 years old. Up to that age 



Statements of Patients. 51 

lived a very exposed life. Did not remember when 
he did not smoke or chew tobacco. Nearly all his 
life had to clear his throat in the morning, and while 
endeavoring to do so would become sick at the stom- 
ach. If these efforts were made after he had his 
breakfast, he would throw up his meal. 

Treated him but eight times, with little, maybe no 
benefit. Save not heard from him since. 

Case Y.— Mr. Robt. G. Kane, of Alton, 111, get 35 
years, consulted me Sept. 6th, 1873 for "grass-fever." 
early history. 

When a boy always had a running nose, and kept 
his mouth open. His mother tied a handkerchief over 
his head and under his chin, so as to make him break 
his " habit" of breathing with his mouth open. Could 
not leave it there because it smothered him. This 
condition of breathing lasted until he was almost a 
young man, at which time had his "palate" (?) (uvula) 
clipped off, because of a severe cough. He was at 
this date taken away from college, because of the 
cough, and was given cod-liver oil; At no time had 
headache, ear ache or sore throat, nor any kind of a 
pain, nor was he ever conscious of taking the least 
cold. 

This is the kind of case that both Dr. Beard and 
Dr. Wyman would say was not liable to " take cold," 
because the patient says that he has had no cold, 
therefore there would be no necessary relationship 
between his "grass-fever" and his very severe chronic 
nasal catarrh, the proof of the existence of which he 
had just given, yet he insists that he has never taken 
a cold in his life, proving that one may take cold, 
even very frequently, without being conscious of it, 
as he undoubtedly did. 

As I required hitnto d's3ontinue the use of tobacco, 



52 Statements of Patients. 

which he acknowledged wasinjuringhim, he preferred 
to go to the Lake Superior regions, where he could 
carry on his excesses and still be free from his pru- 
ritic catarah. 

Case YI. — Mr. Francis B. A., Hannibal, Mo., set 34 
years consulted me June 16th, 1874. 
earta t history. 

Eequired the frequent use of his handkerchief when 
he was a boy. Was always very small for his age 
until he attained his 19th year, then grew up rapidly. 
Up to this age they considered him very liable to take 
consumption, for which he took cod liver oil for 
nearly three years. To this remedy he attributed 
his sudden growth and subsequent good health. Had 
not been liable to very bad colds, but took slight colds 
eve?y winter. This he knew because ho experienced 
difficulty in singing. At the ago of 22 years he ac- 
quired the habit of smoking tobacco. In a short time, 
may be six months, he observed that he breathed 
with difficulty through both nostrils, especially through 
the left one, and slept with his mouth open, so that 
his throat was very dry and slightly sere every morn- 
ing. At the same time he had severe coughing spells 
in the morning and in his effort to clear his throat 
would frequently end in throwing something off his 
stomach. As soon as this took place he considered 
his cough over for that morning. 

The severe sneezing and the weeping of the eyes 
commenced last July (1873) while on a train. At 
that time, he would put a silk handkerchief over his 
nose, as he passed from one passenger car to the other; 
in this way he, in a measure, escaped the bad effect 
of the wind, the locomotive smoke and the dust. Some- 
times on entering the car he would sneeze fifteen or 
twenty times before he could attend to his duties as a 



Statements cf Patients. 53 

conductor. This condition of his case lasted until the 
first snow. In the early part of this month (June 8, 
1 874) he experienced the same sensation in an exag- 
gerated form. 

Treated him from the I6th to the 21st inclusive 
once each day, the effect was all that could be desired. 
His relief was so marked that he thought that the 
complaint was going away. Being convinced of this, 
he started home Sunday night the 21st, but he re- 
turned on Thursday the 25ih, feeling as bad as ever. 
As he had vexed me by going home so suddenly, and 
as the appearance of his eyes was far worse than 
when I first saw him, I, at that time, refused to 
take his case, but in the evening of that day, I gave 
him another treatment, the effect of which was not 
at all encouraging. The fact was, 1 had made too 
great an effort to benefit him by the applications, and 
the result proved that he was too strongly treated, or, 
in other words, he was over- treated, therefore made 
worse. 

I treated him Friday and Saturday, the effects of 
which were highly encouraging. I concluded to miss 
Sunday; this was found on Monday to be an error on 
my part, as the itching in his eyes returned to a 
slight degree. He was treated once each day during 
the next seven days. As he remained in good condi- 
tion, I concluded to pass the next day, Monday ; this 
was another error in treatment, but the itching was 
but slight, in fact, scarcely perceptible, but sufficient 
to determine me to treat him once each day for the 
next seven days, at which time one days intermission 
was again tried and found to be sufficient. 

He was treated every other day until Aug. 1st, at 
which time he went home entireljr recovered. 

He took spray producers with him and continued 



54 Statements op Patients. 

the applications at such time as he felt the necessity 
for them. 

I learned that he had passed the next three years 
without the least return of the complaint. Since 
that time I have not heard from him. 

Case VII.— Mr. Wm. C. F., Kirkwood, Mo., set. 
about 50 years, consulted me May 2nd, 1874. 

EARLY HISTORY. 

Had enlarged tonsils since he has been ten years 
old, and frequent abscesses in the throat (tonsils) in 
the fall months. Has always had tinnitus aurium. 

Last Aug. (1873) had severe attacks of itching of 
the eyes and sneezing whenever he went through a 
clover field. A week before coming to me he felt the 
same sensation coming on again. As he was told his 
complaint was " hay- fever " he concluded to try the 
effect of treatment. He was quite a large man and 
had a few attacks of short breathing that resembled 
asthma. 

The first treatment was quite beneficial. I re- 
quired that he should avoid the clover and hay field, 
this he did. He was treated the next two days and 
felt so well that he passed the next day without treat- 
ment. May 6th came for treatment, felt well since 
last visit. Was not treated until the 11th ; had a slight 
sensation of itching and a few sneezes the day before; 
treated the 17th \ then again on the 19th and 23d. 
As he felt entirely well he concluded that he did not 
require further medical treatment. 

July 25th returned for treatment; had a few sensa- 
tions of return during the week. Was treated again 
on the 80th, Aug. 20th, 26th and Sept. 3d. 

As he had no evidence of his "pollen-fever " he did 
not deem it necessary to take further treatment at 
that time. 



Statements of Patients. 55 

He passed the spring of 1875 feeling in unusually 
good health, but by advice avoided clover and hay 
fields. Oct. 23d, 1875, came again for treatment, 
" driven by thirty or forty sneezes that almost killed 
me yesterday." 

He sneezes very strongly, and being a man of about 
225 pounds, it tortured him very much. When he 
sneezed yesterday, he came near falling off his chair, 
having no control of himself while in the spasm. 

Was treated again the 25th, 27th, 29th, Isov. 3d 
and 10th. 

He was treated three times in Aug. 1876, more as 
a precautionary measure than as a necessity. I have 
not treated him since; nor have I heard concerning 
his health, but I have every reason to think that he 
has remained well, as he still lives in this county. 

Case YIII. — Hiss O. H., principal of one our public 
schools, set, about 38 years, consulted me March 4tb, 
1874, because of stoppage of the nostrils, severe fron- 
tal headache and weeping eyes. Her eyes began to 
itch Feb. 26th ; this had been increasing to her great 
annoyance and was especially severe at night. 

EARLY HISTORY. 

Has been subject to sore throat since she was a girl, 
also to severe headaches. For many j-ears has had 
to clear her throat in the morning, which occasionally 
made her sick at the stomach. 

The treatment gave her immediate relief. She was 
directed to come the next da}% but she did not come 
until the Saturday following, the 7th. She had but 
slight return of her symptoms. Was treated again on 
the 8th, 11th, 14th, 17th and 21st, and not again 
until Dec. 25th; then once each day until Jan. 1st, 
following. 



56 Statements op Patients. 

She is still in the city, and so far as I know, re- 
mains well. 

Case IX. — J. M. C, set. 29 years, sent to me by 
Dr. A. B. Barbee, of this city, consulted me Sept 21, 
1874, for relief of a severe tickling cough accompanied 
•by symptoms of " hay-fever." 

early history. 

Did not think that he took cold when a boy, at 
least did not know it, but had " running ears " until 
he was about 17 years old. Has always considered 
himself as one of the healthiest boys of the family. 

One year ago he felt itching symptoms in a slight 
degree, and was then informed that he was taking 
" hay-fever," In the early part of this month he had 
occasion to catch a horse that was in a timothy and 
clover field, and in doing so became quite warm from 
running after the animal. About the time he got near 
enough to the horse " a spell of sneezing would come 
■on," which frightened the animal away from him. 
He had noticed that his eyelids adhered together in 
the morning for a few mornings before this attack 
came. on. To the dried, encrusted secretions that ad- 
hered to the eyelashes' he attributed the intense itch- 
ing that he had experienced. He did not sneeze more 
than five or six times, " but the first sneeze closed the 
nostrils completely." In fifteen or twenty minutes 
he could breath as freely as usual through the nostrils, 
and would continue to do so until the next sneezing 
spell. 

He was treated once each day for *six days. The 
first application of vaseline gave him immediate re- 
lief. Treated him about three times each week for 
seven weeks, then twice a week until J^o-v. 21st. 

The next spring he went to Minnesota and remained 



Statements of Patients. 57 

free of the complaint up to two years ago, the last 
time I heard from him. 

Case X. — Miss M. M. N., New Harmony, Mo., set. 
20 years. Sent by Dr. A. Ashford, consulted me June 
17th, 1875 for relief from a severe attack of pruritic 
catarrh (hay-fever). 

EARLY HISTORY. 

Up to three years ago was very liable to take colds 
daring cold, damp weather. Has suffered for many 
years with "very severe, blinding headaches," so 
much so that she could not continue her studies at 
school. The headache had such an injurious effect on 
her eyes that she could not read without the aid of 
glasses. Has had " quinsy sore throat " almost every 
winter during the lastten years excepting last winter, 
which was passed without an attack. 

For one or two years past, except during the last 
two weeks before she came to me, she had been unu- 
sually free from headaches, colds in the head, sore 
throat and dyspepsia. This attack commenced on 
May 31st with short breathing which was occasioned 
by a tickling cough. At the same time she had weak 
eyes, which soon began to itch so severely that she 
occupied her time, for half an hour after going to bed, 
in rubbing them. The severest sneezing fits were 
usually after she had been in bed for a few minutes, 
or until the bed clothes sot warm. She wet handker- 
chiefs by the dozen. 

Gave her treatments on June 17th and 19th. These 
applications gave her so much relief that she thought 
she could miss one day's treatment, which she did. 
Was treated about three times a week until the 5th of 
July, at which time she had a slight" sneezing spell;" 
she was then treated once a day for ten daj-s, and 
then twice a week for three weeks. She went home 



58 Statements of Patients. 

on the 7th of Aug. completely relieved of every symp- 
tom of the complaint. 

The next year, on Aug. 4th, 1876, she returned for 
treatment, but had experienced no symptoms of an 
attack. She had learned to treat herself by means of 
the spray producers. This had a beneficial effect on 
her head and throat. Daring this visit she received 
fourteen treatments between the 4th of Aug. and the 
16th of Sept., at which time she returned home. 

Asa usual thing patients who attempt to treat them- 
selves make a complete failure of it, but this young 
lady was quite an adept in handling the instruments. 
I discourage self-treatment, because of the inabi- 
lity to use the instruments properly, and the lack of 
judgment as to the quantity of the remedies to be 
applied. 

I have not heard from the patient since. 

Case XL — Mr. L. M, R., set. 47 years, a merchant 
of this city, consulted me Sept. 30th, 1875, for treat- 
ment of a pronounced and long standing case of " hay- 
fever." Every year since 1863 he had to go East, 
North or West for relief. Hud tried almost every- 
thing, but found no relief; had no faith in anything 
except high altitudes. 

EARLY HISTORY. 

Had been liable to take cold all his life. Never did 
take good care of himself; is not able to do so now. 
(It was evident that when he did not have the attack, 
he did not have the least thought of the consequences' 
of his numerous indiscretions.) The itching of his eyes 
almost always commenced his trouble. The dust of 
his store was his great dread. He said " When I start 
to sneeze I believe that I would sneeze my head off r 
if I did not cover it with a silk handkerchief and my 
soft felt hat. I have tried to see how lonsc I would 



Statements oe Patients. 59 

sneeze without my handkerchief, but I did not have 
the courage to stand it long enough to see if it would 
stop while my head was uncovered." 

When he first visited me his eyes were very red and 
his nostrils completely closed. The treatment gave 
bat a slight relief. He ought to have been treated the 
next day, bat I did not " lay the law down to him 
soon enough." Oct. 2nd the treatment had a very 
beneficial effect, But it was evident that he was not 
taking care of himself, except when he " had to." Was 
treated the 3d and 4th, then missed a day and was 
treated the 6th and 7th. 

The treatment on the 3d and 4th gave him entire 
exemption, so that he thought he was " not going 
to have a very bad spell, anyhow ;" but his sneezing 
returned on the 6th, on which day ho was treated. 
He did not feel at all assured by the treatment on the 
8th, so took the cars that night for Denver, Colo., t*> 
which place he has resorted every fall since that time. 

Case XII. — Clara T., set. 8 years. Sent by the late 
Dr. Frank Porter, of this city, consulted me Sept. 29, 
1875. Was first attacked with sneezing on Aug, 22nd, 
of that year, while she was gathering flowers. At 
this time she got her face poisoned by " poison ivy," 
which laid her up in bed for nearly two weeks. After 
she recovered from this inflammation, the sneezing 
would instantly commence as soon as she went into 
the sun or looked up into the sky on a bright day. 

PREVIOUS HISTORY. 

Always had been a small, nervous child; tonsils en- 
larged since infancy. Had ear disease and rupture of 
the membrane tympani of both ears when about 4 
years old; has had no trouble with them since. Slept 
constantly with her mouth open and made a very 



60 Statements of Patients. 

loud, choking noise while breathing. For two or 
three years she had to lay on high pillows during cold 
weather, to enable her to breathe without disturbing 
the remainder of the family. 

Treated her on the 29th and 30th, Oct. 1st, 2nd and 
4th, These treatments relieved her so much that her 
mother did not bring her back until Nov. 6th, then 
again on the 15th and 17th. She visited me again for 
treatment of her enlarged tonsils, March 17th, 1876, 
and has since remained free from pruritic catarrh. 

Case XIII.— Miss Emma C, of Trenton, Mo., set. 
26 years, consulted me July 30th, 1876, for relief of 
" rose-fever." She was attacked with this complaint 
three years ago. The first year the attacks were not 
very frequent nor severe, but the disease increased 
each year since. The attack commenced this year on 
the 4th of July, while enjoying herself at a picnic in 
the woods. It was so severe that she held her head 
in her lap for nearly one hour before she could en- 
dure the light, her eyes being much more affected than 
her nasal passages, that is they were far more pain- 
ful. She was enabled to go home after tying three 
thick veils over her face and around her head. After 
she arrived at her home, she had a severe chill and a 
high fever during the first part of the night. 

EARLY HISTORY. 

Has had chronic catarrh for many years, and with 
it a cough every winter. 

The first treatment was given with too great an air 
pressure on the spray producers, and. for this reason 
did not give the relief that I anticipated. Treated her 
again the next day with the best effect. These treat- 
ments were continued once daily for ten days, then 
three times a week for three weeks, at which time she 
was unexpectedly called home. 



Statements of Patients. 61 

April 4th, 1878, I treated her again for three weeks, 
three times each week. 

I have no knowledge of her condition since then, 
but have every reason to believe that she has remained 
well. 

Case XIY.— Mr. James L., a merchant in this city, 
set. about 38 years, consulted me on June 6th, 1876, o;i 
account of a severe cold in the head. He had been a 
victim of hay- fever for about four years. Each year 
his complaint commenced about the 20th of August. 

Examination by the pharyngeal mirror revealed 
nothing unusual except chronic inflammation. 

I gave him ten or twelve applications with the 
spray producers No's 3, 4, 5 and 2. The last applica- 
tion started him to sneezing, which he feared would 
commence an attack of hay-fever, but it did not. He 
was relieved of the cold in the head, but received no 
further applications, preferring to make a visit to the 
West for relief and relaxation from business. 

He returned to my office June 4th, 1877, to be 
treated for a severe cold affecting his throat as well 
as his eyes and nose. His trip to Denver, Colo., was 
productive of much benefit to his health. 

EARLY HISTORY. 

At first thought he had not been subject to frequent 
colds while a boy, but upon conversation with his 
father recollected that he had had scarlet fever very 
severely when 7 years old, which left. him very weak 
for several years, especially during the winter months. 
When 20 years old, the late Dr. Pope took a large 
tumor from his nose j he had forgotten which side ; at 
that time his mother told him he had a bad breath. 

Treated him daily from 4th to the 10th. Then three 
times a week for three weeks which relieved him. 



62 Statements op Patients. 

Recommended him to return during the early part of 
August, for preventive treatment for his "hay-fever." 
He did so, and was treated Aug. 9th, 10th, 11th, 12th, 
13th, 14th, 16th 18th, and daily until the 23d, at which 
time he had his attack of hay-fever. On the evening 
of this day he started for Denver, Colo. As he felt 
entirely well by the 20th of Sept. he returned. 

He visited me again on July 29th, 1878, for preven- 
tive treatment. He was treated three times a week 
for three weeks; commencing on the 18th of Aug. he 
was treated daily for two weeks. After Sept. he was 
treated every other day until the 15th, then discon- 
tinued, entirely well. 

He was again treated a few times during July, 1879 
and 1880. Since that time he has remained well as 
far as I know. As he lives in the city I am sure that 
he would have returned if he had not remained in 
good health, as I now have one of his relatives under 
treatment. 

Case XY. — Mrs. G., set. 52 years, a German from 
Quincy, 111., consulted me on June 26th, 1877, for ex- 
cessive fits of sneezing. She would sometimes sneeze 
as many as eighteen or twenty times before stopping, 
but usually not more than ten or fifteen times. These 
attacks would come on every ten or fifteen minutes 
or half hour. As she was quite a heavy woman, these 
sneezing spells wearied her very much. These attacks 
commenced five weeks previous to her visit to me, 
and were constantly increasing. 

Examination showed excessive redness of the muc- 
ous membrane, and it was much swollen, both nostrils 
being closed. 

Yaseline and three drops of the pinus comp. was 
sprayed by the No's 4 and 5, vaseline alone by the 



Statements of Patients. 63 

No. 2. Three applications were made daily for about 
two weeks, then every other day for three weeks. A 
laxative, diuretic and tonic were prescribed. 

At the end of the first application her symptoms 
were very much ameliorated, so much so that she had 
no more severe sneezing fits. In two weeks all sneez- 
ing ceased, and every symptom disappeared after 
three more weeks of treatment. 

On May 5, 1881, she returned for treatment. After 
her last treatment, four years ago, she remained en- 
tirely well until thefollowingMarch, at which time she 
took several severe colds, which brought on a short- 
ness of breath, resembling asthma. She now lives 
near Decatur, III., where she thinks she has taken 
more cold on account of the flatness of the country. 

EARLY HISTORY. 

Up to the age of 22 years, the time that she was 
married, she was always sickly. Had sore throat al- 
most every winter, and a bad cough. Had headache 
until she was about 40 years old. Always had trouble 
in clearing her throat in the morning, and was some- 
times quite sick at the stomach after and while 
coughing. 

I treated ner for chronic nasal catarrh. The treat- 
ment lasted until July. The first three days, once 
daily, then three times a week until June 11th, then 
twice a week until July 5th. 

She has remained well since that time, but has re- 
ceived five or six treatments for her chronic nasal 
catarrh during Oct. 1883, and once in April, 1884. 

These histories of my patients prove what I pro- 
posed to do, namely that pruritus rhinitis catarrhus 
is one of the sequences of chronic nasal catarrh. 



CHAPTER V. 

Local Symptoms ; Subjective and 
Objective. 

It is impossible to give the local symptoms, so that 
they may be seen in every case that may come 
to the readers observation, for the reason that all 
symptoms vary according to the age of the complaint 
and the temperment of the sufferer, but enough can 
be given to pretty fully portray the peculiarities of 
the ailment. 

the skin. 

The skin of the nose and face is frequently the first 
to be affected by an itching sensation. Sometimes 
it is a little hightened in color, even before it is rub- 
bed and appears as though a rash was about to break 
out. Then this sensation extends to the scalp, on the 
back of the neck, between the shoulders and under 
the arms. In extreme cases the integument of the 
whole body suffers to some extent. 

After the complaint has lasted about one week, and 
the skin has been vigorously rubbed in the attempt 
to relieve it of the itching, an eruption is frequently 
observed, resembling prurigo. Sometimes the angles 
of the eyes, especially the inner, become quite in- 
flamed, which the ever-present itching induces the 
victims to aggravate by more rubbing, until small 
crusts form on the irritated spots. Slight ulceration 



The Skin and Eyes. 65 

appears at the alee of the nostrils, causing considerable 
suffering when the itching compels the victims to 
severely rub the parts for relief. The same kind of 
breaking out, or herpetic appearance is observed 
around the mouth. 

Some cases suffer from extreme itching on the an- 
kles and wrists, and when rubbed, becomes swollen 
and sore ; then pustules appear, which when rup- 
tured do not quickly heal. 

Most patients perspire easily and freely, then the 
skin becomes excessively sensitive to even slight 
draughts of air, and become cold and clammy. 

A peculiarity of the eruptions is its sudden appear- 
ance and disappearance, lasting frequently but a few 
minutes or hours. When such is the case, the skin 
is very easily chafed, especially around the neck 
where the band of the under-vest rubs the parts. 

Dr. Wyman mentions a case who "had redness of 
the skin of the color of a boiled lobster, compelling 
him to keep bis bed five days." 

THE EYES. 

The eyes come next in the succesion of being the 
most early and most frequently affected, the itch- 
ing — the characteristic of the complaint — usually com- 
mences at the inner corners. If the left nostril has 
been the one more affected with the chronic catarrhal 
inflammation, then the left eye is the first and more 
severely affected with the itching. The irritation 
always reddens the conjunctiva, then the whole eye 



66 The Eyes and Nasal Cavities. 

is suffused in tears, the lids become swollen and 
in the morning they are agglutinated to each other 
by the Meibomian secretions. On awaking in the 
morning this instantly gives rise to an attack of itch- 
ing of the eye-lids, which instantly extends to the 
nostrils. So "unanimously/' as one of my patients ex- 
pressed it, does this take place, that he was unable to 
say which part was first affected. This condition of 
things lasts but a few seconds when the nostrils are 
completely closed, apparently on account of the tears 
flowing down the lachrymal canals. 

The tears have a positively irritating effect on the 
cheeks as they now from the eyes. When the eyes 
are in this condition, a bright sunlight is so very ag- 
gravating that the victims instantly endeavor to shut 
out the light by placing both of his hands over his 
face. A dark, cool room is the only place in which 
he can quickly recover from his attack. 

A peculiarity is, that after the attack, the conges- 
tion of the bloodvessels as suddenly disappears as the 
attack appeared, leaving no visable trace behind, al- 
though in some cases sties are apparently the result of 
the excessive hypersemia of the lids. 

THE NASAL CAVITIES. 

The nose is sometimes the location from which the 
pruritic symptoms originate. This may be started 
by a slight push in any direction but especially if 
given side wise. I had one patient whose principal 
agony came from minute boils that formed but did 



The Nasal Cavities. 67 

not entirely heal up until the season was past. In 
some patients the muscles connected with the nose 
were in almost continual sposmodic contraction a kind 
of coreaic condition just previous to an attack of 
sneezing. The nasal passages, according to Beard 
and Wyman are the parts that most frequently suffer 
first and most severely. The sneezing is occasioned 
by the itching. The first wink of the eyes sends the 
irritating tears down the lachrymal canals which in- 
stantly starts the itching, this is followed by sneezing 
and a largely increased flow of nasal mucous that com- 
pletely occludes the nasal passages. If the victim 
blows his nose, as he feels inclined to do, this will 
aggravate the matter, by causing a full, wedged sen- 
sation in the cavities. 

It is remarkable that the excessive congestion of 
the mucous membrane does not more frequently lead 
to nose-bleed. Dr. Wyman mentions a case who had 
nasal hemorrhage, I have not seen one. 

As soon as the paroxysm is passed, the passages 
slowly open so that respiration can be again carried 
on through them. The nostril that wa3 usually ob- 
structed during the chronic catarrhal stage will be the 
occluded one during the paroxysms. 

As the paroxysms are most severe and. most fre- 
quent in the mornings, the nasal obstruction will oc- 
cur at this time of the day also. 

The quantity of the nasal discharge, in one morn- 
ing varies from wetting five or six handkerchiefs to 
twenty. In the older cases, the secretion is of a 



68 The Pharyngo-nasal Cavity 

watery nature, except at the close of the season, when. 
it is somewhat "sticky" bat with those who have had 
but " two or three seasons of it, " the secretion is 
always "sticky," and toward the close of the season, 
the purulent character is quite marked. 

In a few cases a spirt of violent exercise, to the 
extent of producing a gentle perspiration has an open- 
ing effect on the nasal passages, and a quieting effect 
on that days attacks, 

In every patient the mucous membrane was ob- 
served to be in an excessively hypersemic condition, 
and of a dark, purplish -red color. The blood vessels 
usually plainly visible during the chronic catarrhal 
stage were not in sight. 

The sense of smell is always obtunded, and odors, 
that before gave pleasure while not causing the least 
irritation, have usually a disagreeable effect, still 
they were unrecognisable. 

THE PHARYNGO-NASAL CAVITY. 

The pharyngo-nasal cavity is always less severely 
affected than the nasal cavity, but an itching sensa- 
tion is felt here also. The only means of relieving 
this part is by coughing, retching and vomiting. All 
of my patients had the coughing and retching, and. 
most of them had the vomiting. 

The mucous membrane while not so deep a red 
color as the superior turbinated processes, was quite 
dark red, and in some patients the membrane had an 
©edematous appearance. 



Soft Palate and Larynx. 69 

The subjective symptoms due to inflammation in 
this locality are almost uniformly felt in the throat 
and for this reason patients try to relieve themselves 
by coughing. 

VELUM AND UVULA. 

The soft palate and the uvula are very frequently 
the seat of an itching sensation. In severe cases, at 
the end of the season, the velum is frequently in a 
paretic condition, so much so as to allow fluids to 
pass up into the pharyngo-nasai cavity and nostrils. 
In a few cases the uvula is slightly cedematous ; in 
one patient it was so dropsical that it almost filled 
the whole space between the enlarged tonsils. In 
this patient the sense of suffocation on assuming the 
horizontal position, was so great that he slept in an 
arm chair ail night. In some the uvula is so much 
elongated that it acts as a foreign body in maintain- 
ing the cough. 

EUSTACHIAN TUBES AND MIDDLE EARS. 

The itching sensation sometimes extends up the 
Eustachian tubes to the middle ears. As soon as these 
cavities are reached a fine sucking sensation is experi- 
enced in the root of the tongue, showing that the 
chorda tympani nerve is affected. In about a fourth 
of my patients their hearing was manifestly decreased. 

FAUCES AND LARYNX. 

On account of the excessive effort to relieve the 
throat of the itching sensation by coughing, the whole 
surface is much congested and in an excessively sen- 



70 The Tonsils. 

sitive condition, so much so that it requires some dex 
terity to make an examination and to apply the 
spray producers. 

A paretic condition of the faucial muscles is scru- 
tinies observed, and with this the parts lose their 
proper sensation, that is become anaesthetic, so that 
it is quite a labor to swallow food. 

THE TONSILS. 

The tonsils are not often swollen, but are fre- 
quently quite painful, and are particularly so when 
swallowing. This pain is sometimes felt up in the 
ears, or if one tonsil is alone affected the correspond- 
ing ear is the one in which the pain is felt, and the 
hearing in this ear is always defective. 

When both tonsils are swollen and painful, and the 
nostrils are closed, eating and drinking is a somewhat 
dangerous operation, on account of the liability of the 
food being either driven up into the pharyngo-nasal 
cavity or allowed to partly pass into the larynx; in 
the latter event give rise to severe spasmodic coughing 
and threatened asphyxia 

If the nostrils are occluded, so that respiration it* 
carried on through the mouth, the lips, gums, tongue, 
soft palate and throat all become dry and parched, 
and all seem as though it was impossible to move or 
use them, but as soon as a little water is taken into 
the mouth, and made to bathe all the parts their fac- 
ulties return. 

The secretion from the throat is quite tough if it 



The Trachea and Lungs. 71 

is not profuse, and the effect to get rid of it frequent- 
ly maintains the throat in a sore condition. I have 
had but one patient who had severe itching in the 
roof of the mouth all the others had this sensation in 
this locality but slightly. 

THE TRACHEA, BRONCHIAL TUEES, AND LUNGS. 

The itching extends from the fauces to the larynx, 
and thence to the trachea and lower air passages. 
This sensation is the sole cause of the spasmodic ac- 
tion of the lower air passages, or in other words, 
the asthmatic symptoms. 

The cough does not commence until the parts are 
very much irritated by the endeavors of the victim to 
relieve himself of the itching;, For this reason the 
cough is observed in the second and third week of 
the pruritic season. The itching is sometimes felt in 
the trachea or at least the victim asserts that it is deep 
in the chest, where one would locate the wind-pipe. 

If the sufferer is awakened by the itching sensation 
in his face, eyes or nose, before he gets through at- 
tending to these parts with his hands, his tongue is 
called upon to relieve the same sensation in the roof 
of the mouth, and a rasping cough is raised for the 
purpose of relieving the throat, and instantly on this 
attempt being made the same sensation is felt in the 
larynx, trachea and even in the bronchial tubes. 

DECEPTIVE SENSATIONS. 

The sensation experienced in the throat, is occa- 
sioned by the itching in the pharyngo-nasal cavity. 



72 The Voice. 

This is easily proven by the application of a soothing 
remedy used by means of the spray producer that 
throws a vertical stream. If this is the case, then it 
is evident that coughing or clearing the throat will 
not relieve the irritation located up behind the soft 
palate, at least five inches above the vocal cords the 
locality of the cough, and it is also as evident that 
the less that the patient coughs, the less irritation to 
the vocal cords, the larynx and the throat, not to 
mention the effect of a fruitless cough on the air pas- 
sages in the la rigs. 

Some patients are so wearied by their efforts at 
coughing that they can hardly stand ; the cough is 
especially fatiguing if the expectoration is scanty, 
in this case the efforts at relieveing the throat of the 
itching sensation is brought about by retching and 
frequently by vomiting. 

THE VOICE. 

The voice is soon affected, so that hoarseness is a 
constant symptom after two or three weeks coughing. 
The color of the vocal cords is the same as that of the 
surrounding mucous membrane, instead of being a 
pearly white resembling the sclerotic coat of the eye. 

• ASTHMATICS 

Toward the latter part of the "pruritic period" the 
symptoms seem to be less severe in the eyes, face, 
nasal passages than ever and a slight cough is suffi- 
cient to bring on short breathing or asthmatic symp- 



Asthmatics. 73 

toms. I ana satisfied that if the patient could be re- 
lieved of the irritation that produces the irresistible 
desire to cough, the asthma would not follow and 
those who had but slight or no cough were as free of 
asthma, while those who early commenced to cough 
frequently and severely, were afflicted with asthma to 
the severest degree, in other words, the milder the 
pruritic symptoms the milder the asthma. 

A dinner, made hearty by the use of stimulants, is 
apt to induce short breathing, but it is not a genuine 
attack like the one that comes on immediately after 
the first coughing spell on retiring for the night, 
these attacks cause the victim to grasp the mantel 
piece for support. 

As the pectoral and intercostal muscles are se- 
verely exercised in coughing, this may give rise 
to a pain in the chest, which may fill the patient 
with fear least his lungs are becoming seriously in- 
volved, but even a slight examination will readily 
prove that they are not seriously affected, although 
mucous rales will be easily heard, but this will pass 
away in a few hours, may be to again reappear after 
the next paroxysm. The attacks of asthma that fol- 
low retching without vomiting always last longer 
than when there is vomiting. Why ? Because the 
act of vomiting clears out the pharyngo-nasal cavity 
quickly, whereas the retching alone does not do so, 
showing that irritation in this cavity can have a 
marked effect on the lungs, as well as on the larynx. 



74 The Heart. 

the heart. 
Palpitation of the heart is a frequent sequence of 
of this complaint; so is an intermittent pulse. Most 
patients complain of a soreness in the region of the 
heart after they have recovered from their asthmatic 
attacks. The pulse is not more frequent than would 
be expected after the bodily exertion of the parox- 
ysms. Many of these patients live under the impres- 
sion that they have heart disease, but this organ is 
not affected except in sufferers who have had chronic 
nasal catarrh for thirty-five or forty years. 



CHAPTER VI. 

Constitutional Symptoms. 

A statement of the constitutional symptoms must, of 
course, include much that has been said concerning 
the local manifestations, 

A large proportion of these patients are so unob- 
servant of their conditon, that it is with difficulty that 
premonitory symptoms can be found to exist. A few pa- 
tients have stated, after being questioned several times 
on the subject, that they felt as though they were 
weaker or more nervous; that their appetite was not as 
good as usual; that their urine was a little more highly 
colored; that they did not sleep as soundly, and that 
they felt peevish and cross. Most of these initiatory 
symptoms were entirely ignored by at least two thirds 
of my patients. Those who did have any or all of 
these initial symptoms, state that they probably 
commenced a week or a little more before their anti- 
cipated attack, but were the strongest during the three 
or four days before the attack. 

Some of these patients thought that the mental anxi- 
ety concerning the attack, had something to do bring- 
ing on these symptoms, together with their loss of 
sleep and appetite, etc. 



76 Constitutional Symptoms. 

In a majoirity of the patients the system was 
not disturbed until they had suffered, for nearly a 
week. Then they experienced chilliness followed by 
flashes of heat; their hands and feet burned so severe- 
ly that they felt compelled to bathe them in cool 
water, not cold water, as the latter always caused 
pain. Some preferred tepid water. 

"While they felt a slight burning heat over the whole 
of the body, yet when a cool wind struck them espec- 
ially on the back, they began shivering instantly, this 
was frequently followed by an attack of itching and 
sneezing. Several patients were affected with night 
sweats. 

Palpitation of the heart was a very common com- 
plaint, as well as a soreness or uneasy sensation in the 
left side of the chest, especially after sleeping on that 
side. With many the pulse was slightly accellerated 
and intermittent. 

All patients complain of a want of appetite, not only 
this, but they lose the faculty of taste to some 
degree. Warm drinks are the most pleasant, and hot 
soups keep their place throughout the entire attack, 
as being the most nourishing and grateful. 

"With the diminution of the renal secretion, there 
is constipation of the bowels. Some patients were af- 
flicted with diarrhoea, but this was nearly always found 
to be due to some indiscretion in eating. Indigestion 
and all its usual consequences, was almost always 
present. 

All patients were mentally depressed, were fretful 



Constitutional Symptoms. 77 

and easily angered, and much given to fussiness about 
their meals. Forgetfulness was one of the sequences, 
as well as an impossibility to continue a long time in 
any train of thought. Many expressed doubts as to 
the perfectness of their sanity, or were fearful that 
their mind would give way under the terrible stress. 
The failing or wandering of the mind was most fre- 
quently experienced at night, on waking out cf a sleep 
when attacked by a sneezing spell. Two patients 
were so much terrified by some unaccountable fear 
that they would not sleep in the room without a light. 
These terrors would even follow them in sleep and 
cause them to moan loud enough to awaken those in 
an adjoining room. These mental symptoms were 
always the most severe with the asthmatics, and those 
who had the fall attacks or the so-called autumnal 
catarrh. 

It is remarkable that some victims will undergo 
these attacks and suffer from all of these symptoms and 
at the end of the season proclaim themselves in good 
health, and, because a few people have claimed in 
the public prints and in small works on this subject, 
that they are better after suffering from these attacks, 
they will "follow suit" and make the same expres- 
sions, yet every one of them, if carefully intorrogated, 
will give evidence of the yearly weakening of the 
system, that would not have occurred were it not for 
these attacks. 



CHAPTER VII. 

Course of Pruritic Ehinitis. 

Some authors who have written on this subject, 
-employ language, in describing the attacks of the 
complaint, that plainly indicates that they are not 
averse to using the marvelous, so much so that their 
remarks concerning its peculiarities, require that 
the exclammation point should conclude their sen- 
tences. Nearly the whole tenor of all they say, is 
gauged on this key. Even some of the sufferers 
themselves seem to enjoy this extravagant mode of 
expression as seen from the histories they give of 
their symptoms. Brooklyn's world-famed divine takes 
the lead in this style in describing his case. He 
shows his fondness of the graphic in detailing his 
attacks, and one would be really excusable in think- 
that he was in rather good humor with himself while 
giving his account of them. I do not mean to ques- 
tion the correctness of what he says, but I insist that 
the exhibition of the marvelous is manifest and i3 mis- 
leading. 

The point I wish to make is this. If a complain- 



In the Beginning, Attacks Irregular, 79 

ant's symptoms do not come up to this marvelous gage, 
or his expressions are not given in this key, they are 
without exception, not included in the hay-fever list; 
consequently, the true commencement of the com- 
plaint is not observed, because the first, the initial 
manifestations are so very slight, that even the victim 
himself does not recognize the tendency of his symp- 
toms, for this reason there is no opportunity for 
flights ofrhtoricin describing his feelings. 

Not long ago, I had a patient say : "I would believe 
that I was affected with hay-fever, if I was not so 
well acquainted with the symptoms of this disease. 
My uncle has had it for many years. He has it on 
the 12th day of June every year, at the same hour in 
the morning and it leaves him in just five weeks, 
whereas my symptoms last different lengths of time, 
and may come on at almost any time of the first four 
months of the year." 

I know of a gentleman who said: "I had my first 
attack on the 20th day of April and it lasted until 
frost, at the same time I was in real good health. I 
had no regular time for my itching and sneezing, 
neither of which are severe. I sometimes have it one 
time and sometimes another. One year ago I had it 
in February; this year it commenced in May. One 
time I had it in the last week in December; this was 
three or four years ago. I had. almost forgotten it. 
I am sure that it is getting worse every year, and 
may be it will turn into real hay-fever if it is not 
stopped." 



80 Cases to Prove its 

This is a fair history of at least thirty cases that 
have come under my observation. 

The forgetfulness of these patients, which is almost 
proverbial ( at least with those that I have seen ) 
makes it difficult to get an accurate and full history 
of their condition before their attack, but careful in- 
terrogations, made from time to time during their 
visits for treatment, will always elict the fact that 
they had attacks of itching of the eyes, face, nose, 
etc, with sneezing during the late winter and early 
spring months, and that they were thus afflicted for 
from one to seven years previous to the full formation 
of the complaint. 

This view of the commencement of pruritic catarrh 
can only be established by facts obtained from patients. 
This I propose to do by giving the histories of a num- 
ber of patients who have suffered more or less from 
this complaint. 

Case XVI. — Mrs. A. E. sst. 47 years consulted me 
Aug. 25 1883. Complained of having a severe cold in 
the head and disease of the right antrum of Highmorc. 
Since the middle of July 1883, she suffered from what 
she thought was a continous cold, accompanied by 
severe sneezing and itching of the eyes and throat. 
On her first visit she stated that she did not have these 
symptom at any previous time, but on further conversa- 
tion on this subject, on the 5th of Sept. following, she 
remembered having had these "sneezing spells" dur- 
ing the warm weather of the past five years, and that 
they had been gradually getting worse, these " sneez- 
ing spells" were accompanied by symptoms of 



Gradual Commencement. 81 

asthma, which was more severe this year than at any 
time previous. 

Case XVII. — Dr. E. L. sot. 44 years consulted me 
June 13th. 1884, He had had nasal catarrh for 25 
years, but not very annoying until 10 years ago, since 
that time, it had been noti cable to others that he took 
cold more frequently in warm weather, so much so 
that he was not able to attend to business without 
much suffering. In the spring, when the "fuzz" was 
blowing off the trees, his eyes became inflamed and all 
of his catarrhal symptoms were much aggravated. 
Towards the close of the season he had symptoms of 
asthma. He was sure that his " hot weather catarrh " 
had become more aggravated each year, and with it, 
his asthmatic symptoms. 

CASEXYIII.-Miss.M. Collinisville, 111. set. 26 years 
sent me, on June 3rd. 1884, by Dr. Wesseler of this 
city. Complains of sore throat accompanied hy severe 
cough and short breathing. 

In June 1873, upon sweeping the floor or making 
feather beds her eyes would commence to itch and she 
immediatly began to sneeze. These paroxysms 
lasted for nearly an hour; before this date she had the 
same sneezing now and then, but never so severe. 
These symptoms did not increase until June 1883, at 
this time she took a very severe cold. She was cer- 
tain that she had sneezed every month since that time, 
especially since last Christmas. At present she sneezes 
only when she is in a draught. Not otherwise except 
when exposed to dust from a carpet. 

Just before she sneezes she experiences itching over 
the eyebrows. The symptoms of sneezing are occa- 
sioned by emanations from a rose or other flowers. 

Case XIX — H. W. set 13, years. Consulted me July 
3rd. 1883 complained of sneezing, swollen eyes, sore 



82 Cases to Prove its 

throat, general debility, nose-bled every day, some- 
times several times a day ; takes cold easily, especially 
during warm weather. When he was an infant about 
3 or 4 weeks old he took a severe cold. 

His mother thinks this was the foundation of his 
catarrhal trouble. In three or four months after this, 
took another severe cold and had inflammation of the 
pleura. He did not take cold like most childern but 
had a watery discharge from his nostrils like an adult. 
Fresh hay did not have any irritating effect, but old 
dusty hay always brought on paroxysm of sneez- 
ing. His mother does not remember his sneezing con- 
tinuously as he does at present, but knows that he has 
been rather sensative to all kinds of dust since he was 
three or four year old. Had not had attacks of 
asthma until the fall of 1882. All of his symptoms 
remained the same until 1880. Since then they have 
been increasing rapidly. 

Case XX. — Mr. A. A. set 17 years complained of 
sneezing and itching of the eyes. When he was 8 
j ears old he caught a severe cold in the cars, that af- 
fected him for nearly a year. On July 18th 1875, 
while in Concord, ~N. H., he went into a ha}^ field and 
was attacked with sneezing, which was so severe as to 
compel him to return home. The paroxysms did 
not fully discontinue until evening, at this time a 
feather dipped in quiuine was put up his nose, but 
this made him sneeze more Beverly, and had the 
effect of maintaining the attack for nearly the whole 
of the night. This application of quinine was kept 
up for some time, with the effect, as his mother now 
maintains, of producing a chronic inflammation of the 
nasal passages, On the discontinuance of the qui- 
nine his paroxysms ceased. At first his phj-sician 
thought that he had hay fever, but as he remained 



Gradual Commencement. 83 

-well and was able to pass through hay fields and 
play with hay it was concluded that he did not have 
the complaint. The next attack of sneezing occurred 
in the later part of May 1876. On its reappearance 
some of his friends thought he had hay-fever, but 
after consultation with a physician it was concluded 
that it was only a cold in the head, the next year he 
again had the paroxysms in May, at this time he was 
sent to Iowa where in a few days all symptoms disap- 
peared. In 1878 he had but few paroxysms of sneez- 
ing. In 1879 the complaint developed itself in full 
force, for which he was treated by three physicians. 
In 1880, his attack was postponed until the 15th of 
June, and for three weeks it was very severe, on the 
12th of August in the same year it again commenced 
and continued for about one week, towards the end 
of September he had a third attack which lasted him 
for two weeks. In 1881 he did not experience any 
sensation until the end of September. In 1882 had 
it slightly in August, and a severe attack of it the first 
week of October. 

Case XXI.— Mr. W. H. M. set 42 years, consulted- 
me May, 12 1885. " For three years I have been sub 
ject to taking cold far more frequent in warm spring 
weather than during winter. My colds have been 
so severe that I have lost my voice. My eyes have 
been weak and watery at such times and I think they 
itched last spring and may be a little the year before, 
but at present I have to rub them to relieve them of 
itching which is now quite severe. I have sneezed 
a good deal for several years, but had not thought of 
having hay-fever." 

The above histories plainly establish the fact that 
pruritic catarrh manifests itself by -slight symptoms 



84 Early Stage. 

at first, and that these gradually increase in severity 
until it takes full possession of its victim, or in other 
words, is so violent in its demonstrations that it forces 
recognition from every one. 

The course of the complaint after it has fully man- 
ifested itself, is of interest to the physician. From 
it he can determine whether or not the complaint is 
decreasing or increasing under his treatment. 

To describe the course of this complaint, I will 
be compelled to take the stages, consecutively, as they 
occur. 

STAGE OF NON-RECOGNITION. 

This is the most important stage; it commences at 
any time from the last week in December to the first 
of July ; but the period for the most frequent attacks 
is in May and June. The victim has been subject 
to colds in the head for years; he has indulged in 
reading at night or has smoked at night, then his eyes 
itch him a little, which he may blame to the smoke of 
his cigar; he has sneezed a little. Even if he is not 
the age to use glasses, he will be apt to question him- 
self concerning the failure of his sight, and will 
seriously think of doing something for this disabil- 
ity. He will notice that they are sticky in the morn- 
ing, and that they are apt to water if he suddenly goes 
into the light, also that this may be accompanied by 
a few sneezes. 

If these symptoms are marked, the usual symptoms 
that he experienced of his chronic nasal catarrh will be 



May and June Form. 85 

proportionally lessened, showing a marked metasta- 
sis of the former complaint to the new one. Indeed, 
this characteristic is observable in all stages of chronic 
catarrhal inflammation of the nasal cavities and all 
of its sequelse, pruritic catarrh not excepted. I had 
one patient who imprudently ate some canned apples 
in June, at a time he was suffering from his attacks, 
which gave rise to a bowel complaint that resembled 
cholera morbus. While ailing with this disease, he 
was entirely free from his slight symptoms of pruritic 
catarrh, and from his severe headaches, the result of 
ohronic nasal catarrh. 

These irregular attacks of itching and sneezing may 
last for a few months or may be for several years, but 
when they assume a severer type, they then take on 
more regular dates of commencement, and discontin- 
ance, and the complaint is then given the name of 
rose-cold or June-cold or July-cold,^according to the 
season of the year in which these regular attacks 
occur. 

This brings us to the recognized 

PRURITIC CATARRH, OR THE EARLY FORM KNOWN 
A3 ROSE-COLD OR JUNE-COLD. 

The facts herewith given will show plainly that the 
earlier the attacks of pruritic catarrh, the younger the 
complaint, and vice versd. 

While these views are not acquiesed in by any au- 
thor that I have seen, yet I will quote from them pas- 
sages and histories of cases, that will prove that I am 
right. The two symptoms, the cough — which comes 



86 Changes its form. 

from pharyngo-nasal irritation — and the asthma, that 
are taken to show the degree of the severity of the 
complaint, increases as the age of the complaint in- 
creases. This is shown by Dr. Beard, on page 111. 

Of 17 May cases, 4 had neither cough nor asthma, 7 
had both. 

Of 13 July cases, 3 had neither cough nor asthma, 
7 had both. 

Of 55 August cases, 9 had neither cough nor asthma 
66 had one or had both, demonstrating that the later 
in the season the attacks occur, the more severe the 
complications. Further on he says: " Others, who dar- 
ing the first years have the early (May) or middle 
(July)form, subsequently have the late form (August). 

In corroboration of this, I will quote from Dr. 
Wyman. He gives on page 148, the histories of 
cases exactly similar to quite a number that I have 
under observation vis : 

"Dr. A. W. W. of Chicago. 111. — Has suffered since 
his eighteenth year, though for ten years it took the 
form of " rose cold" or June catarrh. l Finally six 
years ago the June visitation was 'broken up by 
Jonas Whitcomb's remedy, and I was congratulating 
myself on a cure when August came and brought 
with it the i big brother/ Since that time I have no 
further trouble in June — save it all for August/ 

On page 149 Dr Wyman says : " The June cold 
is less severe and of shorter duration; the eyes are 
less severely and less constantly affected; the cough is 
much less constant, and not spasmodic to the degree 
of producing retching and vomiting; asthma is less 
frequent at the close, but when it exists is sometimes 



Changes its Form. 87 

more severe. * * * * * * * 

"Those who have June cold are seldom subjects of 
Autumnal catarrh. When June cold has existed it 
has generally ceased on the appearance of the latter 
disease." 

On this page he gives the history of some cases 
illustrating what I have quoted: "Mrs. H. at the 
age of 18 first noticed thst she was affected by the 
aroma of roses. The following year, while picking 
roses in the morning, had itching of the eyes, which 
became so intolerable by afternoon that she asked 
medical advice. After this she could not be in a 
room with any flowers without affection of the eyes 
and catarrhal symptoms. This state of things con- 
tinued about ten years, when she began to have her 
regular Autumnal catarrh, and the sensitiveness to 
flowers very materially decreased, but has not entire- 
ly disappeared." 

On page 150, is the following cases : 

" Case 10. — The yearly attack formerly commenced 
in June; now it commences between August 20th 
and 27th, and terminates September 10th to 20th." 

u Case 65. — Mrs. M. — At 16 had catarrh commenc- 
ing in June and ending about July 4th, or during hay- 
ing time. This occured annually for 17 years. Five 
years ago, after some irregularity in its period of ter- 
mination, it ceased altogether, and a catarrh appeared 
about August 1st, when near Fall Eiver, Mass. The 
three subsequent years she was in Origan, Illinois, 
when it appeared August 17th, and this year [1866] 
while in Charlestown, Mass,, August 24th." 

On page 151 is the following case: 

"Bev. J. H. W., who had been a subject of June 
cold from early infancy, writes: ' But it has changed. 
It always had begun in June and continued until the 



38 Changes its Form. 

middle of July; but about ten years ago it began to 
reappear in Autumn. Now it has almost transfered 
itself from June to September. E. #., this year [1872] 
I have had two bad days, one in June and one in July. 
Last year it was about the same ; but with September 
came three terrible weeks, part of which I had to 'give 
up ; and take my bed, for the first time in ten years 
of preaching I lost a Sunday's duty from this cause." 

Many other cases of the same character could be 
quoted from these and other authors. I have the his- 
tories of 23 patients that bear the same testimony. 

This demonstrates the difficulty in giving the course 
cf this complaint, as it differs according to the age, 
temperment and exposures of the victims. 

Once that the complaint has sufficiently marked 
symptoms, the patient will complain of an itching of 
the eyes, but this always occurs after an exposure that 
has resulted in a cold being taken. 

If the itching lasts for a few minutes, the same sen- 
sation is experienced in the nose, then the sneezing 
comes on, first only a few of them, not enough to call 
his or her friends attention. The next day this same 
course is experienced by the victim and is observed 
by his friends, then (in the majority of instances) they 
tell him that he has the hay-fever. 

At first his attacks are not severe, and after they 
have passed away, he invaribly thinks that " it may 
not be the hay- fever, after all." I have not seen the 
victim of pruritic catarrh that did not say this or use 
words to this effect; not only this, if they pass one day, 



July or Middle Form. 89 

they as invariably forget to take any precautions to 
prevent a recurrence. 

After they have had an attack for about a week or 
two, they may begin to have a cough, but this is far 
from being constant, except when the complaint has 
grown to be a few years of age, then asthma in a 
mild form may affect the patient. 

Ail their previous symptoms of chronic nasal catarrh 
will disappear as these new symptoms appear, yet the 
patient will not mark the absence of his old symp- 
toms unless reminded of it by some friend or some 
unusual circumstance. 

At this age of the complaint, there is no premoni- 
tary stage, at least very few patients can remember 
any thing that would resemble that experienced by 
older victims. 

The duration may be a few days, or one or two 
weeks, according to the care the patient takes of 
himselfj and to the exposures that he must encounter; 
about ten days is the average duration. If the first 
on-set passes off in three or four days, his tormentor 
may return with redoubled force. The date of dis- 
appearrnce is always uncertain in young cases, and it 
may be sudden or it may be gradual. 

THE ATTACKS THAT OCCUR IN JULY. 

I do not mean, by thus dividing the description of 
the attacks of this complaint, that they are different 
diseases but a difference only in severity. A good 
illustration of what I mean is to say that the inter- 
mittent, remittent and continued fevers are not three 



90 All Forms one Complaint. 

separate diseases, but three grades of severity of the 
same disease. On this point I agree with Dr. Beard 
he says on page 110, " The unity of the different forms 
of hay-fever, occuring early in the summer, in mid- 
summer, or late in the fall, is proved by the follow- 
ing facts: 

" The symptoms in all three forms are the same in 
kind, differing, if at all, in degree only. The distinc- 
tive symptoms — the sneezing, itching, discharge from 
the nose and eyes, swelling and obstruction, cough 
and asthma, with the febrile state, nervousness, lan- 
guor, debility, and depression — are experienced in 
the early and middle as well as in the latter forms. " 

As seen from the tables showing the dates of attack 
[see index], the number attacked in July are not 
greater than in June, but the severity of the attacks 
are always greater. 

Some might say, that according to my theory the 
number also ought to be greater. It does look that 
way at first sight, but this can easily be explained. 
The early attacks are made more frequent by the 
greater liability to take cold, because the season of 
the year tends to cold-taking. Many of these attacks 
would not have occurred were it not for some indis- 
cretion that could have been easily avoided, and would 
not have happened in warmer weather if the victim had 
taken care. Thus the number of sufferers would be 
decreased, in proportion as the mildness of the season 
made it possible for indiscrete persons to be careless 
of hygienic measures, without taking severe colds. 
The symptoms of this form, the July attacks, do not 



Autumn Form. 91 

differ in the least except as to severity and duration. 
More of them have cough and asthma and the attack 
lasts longer. To repeat them would lead to confu- 
sion. 

THE ATTACKS THAT OCCUR IN THE AUTUMN. 

This is the season for the attacks of this complaint 
after it is well formed, but the symptoms of this state 
also differ only in degree of severity and duration, 
that is, with the average number of the cases. Some 
of the mild autumnal grades are very much less 
severe than some of the severe forms of the July or 
May forms. But few victims of this form esc ape the 
cough and asthma. 

A peculiarity of this stage is that the victim some- 
times out-lasts the complaint, that is, the attacks, after 
coming on regularly for a number of years, slowly 
decrease in severity and then cease altogether. I 
have seen two cases of this kind. Dr. Beard relates 
three cases that "finally disappeared entirely." 



CHAPTER VIII. 

Influence of Location. 

Most of my patients were best pleased with the effects 
of the climate of Colorado, several of whom had visi- 
ted the famous White Mountains. The sunshine in 
the Colorado region does not have the least irritating 
effect on the eyes. Several were greatly relieved by 
a sojourn near Austin, Texas. Several have made their 
residence near Los Angelos, Cal., because of complete 
exemption from the attacks. One of these patients, 
a physician, says that he has never known of an in- 
dividual haviug an attack of pruritic catarrh while re- 
maining in that region. Three of my patients pre- 
ferred the region of Lake Superior, Sault St. Marie, 
and Mackinaw. 

Last year (1884) in August and September, three of 
my patients spent the whole pruritic season at home, 
in a darkened room, maintained cool by hanging a 
piece of ice, ten pounds, each day from the ceiling of 
their apartment, as hereafter described. 

Dr. Beard asked his correspondents the following 
question. " Are you better in the city or in the coun- 
try ?" 



Influence of Location. 93 

His replies were the following : 

Better in the city 28 

Better in the country - - - 12 

No difference 8 

The remainder — 162 — not answering the question in 
any way. This is so unsatisfactory that I consider 
it of little or no value. 

His next question was : " Where do you find the 
quickest and surest relief?" 

His replies were the following : 

At sea 8 

At the sea-side 19 

In mountainous regions 35 

Some portions of White Mountains 15 

.Rocky Mountains .... 7 

In bed in a cool, close, dark room - 8 
As before stated, three of my patients expressed the 
same preference that the last eight did, and one of 
these had been to Denver, Colo., and one to the Ten- 
nessee Mountains. 

Another of Dr. Beard's questions is the following: 
'•Have you ever visited elevated regions without 
benefit ?" 

His replies were " 83 No. and 17 Yes." 
in his detailed replies, the following places had 
been visited without benefit. 

11 Five, specified Catskill Mountains j Lenox, Mass ; 
White Mountains : Little Mountain O.j Mountains of 
Eastern Pennsylvania and Mt. Mansfield ; Overlook 
(3000 feet high) ; Mountainous regions of Connecti- 
cut ; etc." 

Dr. Beard very correctly says : " The information 



£4 Recommendations 

here contained is sufficient to show that there is no 
rigidly defined non-catarrhal line. Elevation is but 
one factor." 

FOR VERY CHRONIC CASES. 

Those victims who have had the pruritic catarrh for 
ten or more years, would do well, after receiving the 
treatment for their chronic nasal trouble — as all of 
them have had this form of catarrh, — to visit and re- 
main at a location that affords them complete exemp- 
tion from its attacks, because the more frequently they 
allow the attacks to occur, the longer the attack will 
will remain and the more surely will it fasten itself 
on them. I believe that a course of treatment, for 
several years, followed by a prolonged visit to some 
region in which they can be free from attacks will ul- 
timately cure the complaint, except in very old 
patients. 

Under these circumstances, where will they go ? 

I have recommended my patients to go to one safe 
region one year, and another the next year, and so on ; 
that is, not to visit any one place, any two years in 
succession, as the patient may become acclimated to 
the place, and thus loose some of the benefits of the 
change. 

OCEAN TRAVEL. 

A voyage on the ocean is the most certain to be 
healthful to these patients. But in so doing one need 
not take a passage on a vessel that is transporting a 
large drove of cattle, sheep, hogs etc., and in this way 
" tempt the evil one/' Those vessels that are freighed 



For Chronic Cases. 95 

with pine lumber, or black walnut lumber, or timber, 
are the best of all. A voyage in a vessel, leaving a 
little before the beginning of the season in which the 
pruritic catarrh commences, bound for some part in 
South America,, say Eio Janeiro is a most pleasant, 
trip, and one that need not be so very expensive either, 
a good thing to be kept in mind, by the way. 

WESTWARD. 

The next best regions are in Cplorado or California. 
ISTo bad reports have come from either of these States. 
While residing in either of these locations, the patient 
should not conclude that he can, with impunity, live 
indifferent to the laws of health. One of my patients, 
who visited the "Far West" said that he " was fool 
enough to acts as though the climate took the contract 
to cure him," consequently he followed his usual in- 
clinations in living carelessly, in utter forgetfulness 
of all hygienic rules. The consequence was that he did 
not receive all the benefit that he might have done 
had he lived differently. 

LAKE SUPERIOR. 

The regions around Mackinaw and Sault Saint 
Marie are reported as excellent for patients afflicted 
with this complaint. The air of this part of the coun- 
try, like the water of this grand lake, is remarkable 
for its clearness, but even here patients must not ex- 
pose themselves to agencies that are known to be 
irritating. 

A TOUR ON THE CONTINENT. 

This is most always very beneficial. Many have 
been permanently strengthened by a three or four 



96 Europe Kecommneded. 

months visit to Europe. In these days of rapid and 
pleasant travel, a trip can be made by a patient who 
is very weak, with an almost certanity of immediate 
relief as soon as land is out of sight. 

A permanent residence in Europe is a sure preven- 
tive of further annoyance from this complaint. Al- 
though it is stated that when Americans return to this 
country, the pruritic catarrh also makes it return, yet 
I am fully of the opinion that were they treated for 
the chronic catarrhal inflammation of their nasal pas- 
sages while there, for a period of three years according 
to the age of the patient, they could return to their 
usual abode with immunity from the attack of the 
pruritic catarrh. 

In closing this chapter I would again urge that 
greater benefit will be received by the traveling vic- 
tim visiting one region one season, and another the 
next season, always looking for a new place of exemp- 
tion. 



CHAPTER IX. 

Causes op the Paroxysms, 
dust. 
Dust of various kinds stands at the head of the list 
of the causes of paroxysms, and the dust of the steam 
cars is the most aggravating; as this is always accom- 
panied by the sulphourous smoke from the locomo- 
tive. The next kind of dust that is to be avoided is 
that from an old carpet, then that from an old feather 
bed, then from a moss bed, after this comes the dust 
from old, moul dy hay and from the street. It must be 
born in mind that in the formative and early stages, the 
cause of the paroxysms is not attributed to dust alone, 
there must always be a tendency and oue or more other 
irritating agencies at work, as sunlight, heat, excesive 
exertion, sufficient to cause perspiration to contribute 
to this result; but dust, of the kind named, seems to 
be the most prominent. 

BRIGHT SUNLIGHT. 

Any kind of very bright light, but especially strong 
sunlight stands next in the list. If the victim should 
lie with his face to an unshuttered eastern window, 



98 Irritating Agencies. 

and suddenly open his eyes so that the full morning 
light will fall upon them, an attack is almost certain. 

EXHAUSTION FROM HEAT. 

Over heating the system stands nextas an irritating 
influence, but with this there must also be over-exer- 
tion to the extent of exhaustion. As these patients 
are easily wearied, even moderate exercise may lead 
to exhaustion. 

The remainder of the list of irritating agencies, 
named as they have proved to be the most noxious, 
are as follows: 

Hay, old and musty, and fresh. 

Sneeze or rag-weed. 

Sulphur matches. 

Smoke. 

Draught of damp air. 

Flowers. 

Air of a mouldy room. 

Cold damp winds. 

Tobacco smoke. 

Foggy morning. 

Night air. 

Damp cloths. 
Of the mental conditions: manifestation of excessive 
ill temper; anxiety, and melancholy, are the most 
prominent. Indigestion is a frequent excitant of an 
attack. 

The sudden, in fact the instant response of the sch- 
neiderian to the irritating effect of the most of these 
agencies, apparently leaves no period for the incuba- 
tion of parasites. Notwithstanding this, I presume 
that, some one will soon lay claim to the discovery of 



Irritating Agencies. 99 

"bacilaris3 peculiar to or may be a cause of this com- 
plaint. The effects of these irritating agencies are so 
instantaneous, that there is no opportunity for imagin- 
ation to act on the victim, as the attack is a surprise 
to every one of them, nor do they know positively? 
for some time, the cause of their paroxysms. 

A close investigation of the effects of these irritat- 
ing agencies, proves that their number is quite large, 
instead of being but a few things, and that hay in any 
form is not the chief cause of the paroxysm, dust of 
various kinds being far the most noxious. This dis- 
poses of the question as to the propriety of calling 
the complaint, hay-fever. 



CHAPTER X. 

Diagnosis and Prognosis. 

The characteristics of increasing severity of the suc- 
cessive stages of this disorder, is plainly demonstrated 
by the table facing this page. 

THE FIRST OR FORMATIVE STAGE. 

Presuming that the reader has scanned this table, 
the work of presenting the diagnosis will be mater- 
ally shortened. 

In proportion as prevention is more important than 
alleviation or cure, so is it important that a diagnosis 
of this complaint should be made as early possible. 

The only disease that might bo taken for the forma- 
tive stage of pruritic rhinitis is a common cold in the 
head. Both complaints are frequently accompanied 
by sneezing, but with a cold, there is no itching of the 
face. If itching ever so slight, should be expierenced 
and it occurs during warm weather, then the com- 
plaint may properly be called the first stage of pruri- 
tic catarrh. 

A common cold does not attack its victims sud- 
denly and it may occur at any season of the year ; 



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102 Fir^tor Formative Stage. 

but should it occur more frequently in warm wea- 
ther, then pruritic catarrh may be suspected, es- 
pecially if its attacks are more sudden than usual 
colds, and if accompanied by redness of the eyes and 
a profuse flow of tears. 

As stated, a simple cold in the head is more liable 
to occur at a season of the year that pruritic catarrh 
does not occur, yet it must be remembered, that the 
pruritic complaint is always preceded by symptoms 
of a common cold, and is usually, nay, almost univer- 
sally taken for a simple cold for a year or two. 

While Dr. Beard, in common with all authors, ig- 
nores common catarrh as the originating disease, yet 
he has passages in his work that fully confirm my views 
in this regard; he says: u In the first attack there is 
always a doubt which may not be settled until the fol- 
lowing year. During the first attack, the severity and 
obstinacy of the symptoms and the season of the year 
are the chief causes that excite the suspicion of hay- 
fever. Those whose first attacks are in infancy or early 
child-hood may not suspect the real nature of their 
disorder until they arrive at maturity. " 

To repeat: if the suspected symptoms be accom- 
panied with itching of the eyes, however slight, and 
with sneezing, and the attack be sudden and especially 
if all this occurs in warm weather, when colds are not 
liable to be taken, then it is altogether likely that 
the victim is suffering from the first, the formative 
stage of Pruritus Rhinitis Catarrhus. 



Second or May and June Forms. 103 

the second or the may and june forms. 

At this stage, the disorder has shown itself plainly. 
It now stands in marked contrast to the symptoms 
accompanying a cold in the head. 

An ordinary cold is far more liable to occur at those 
seasons of the year in which this ailment does not us- 
ually occur; a cold comes on gradually, pruritic cat- 
arrh suddenly; the eyes may sometimes be a little 
reddened in a cold, in this complaint they are almost 
always quite red. 

The pathognomonic symptoms of pruritic catarrh, 
the itching, is not present with a cold; sneezing is ob- 
served in both complaints but far more severe in the 
former ; a cold will not disappear so completely in a 
few hours as will the symptoms of this ailment. 
Asthmatic breathing very rarely follows a cold, but 
it not unfrequently follows pruritic catarrh even in 
this stage. 

Dust does not make a cold in the head worse, at 
least it does not show marked increase because of it, 
whereas pruritic catarrh is almost instantly made 
worse by it. 

Usual medical treatment, such as a foot bath, a sweat 
a dose of quinine, etc., will cure a cold, but with this 
complaint it has but little ameliorating effect. A cold 
has no fixed time to disappear, the other disappears in 
four or five weeks. The pruritic catarrh is frequent- 
ly relieve hy change of residence to certain parts of 
the country, a cold is not. A cold is aggravated by 
cold weather the other is frequently improved. 



104 Third Stage or July Form. 

Nearly all of these contrasting symptoms are well 
defined. 

THE THIRD STAGE OR THE JULY FORM. 

There is still less liability for mistaking this form 
of pruritic catarrh for a cold in the head; all of the 
features of the former complaint stand in marked con- 
trast. The season of the year in which it occurs, be- 
ing such that colds are not liable to be taken, even if 
patients are quite careless in observance of the laws 
of hygiene. 

Ordinary asthma might be confounded with it by 
the uninitiated, but the absence of the itching of the 
eyes, nose and face would show the mistake, besides, 
with asthma there is much greater impediment in re- 
spiration than the pruritic catarrh, except when 
asthma is a sequence. With asthma a cool draught 
of air from an open window is very refreshing, with 
the other it would be very aggravating. 

The asthma that accompanies pruritic catarrh, is al- 
ways preceded by the usual itching, sneezing etc. 
while in ordinary asthma, no such symptoms ever oc- 
cur. The itching and the sneezing that precedes the 
asthma of pruritic catarrh are the only symptoms that 
distinguish it from ordinary asthma, in all other res- 
pects they are identical. 

THE FOURTH STAGE OR THE AUTUMNAL FORM. 

This stage is so peculiarly phenomenal that none 
lout the most obtuse observer would take it for a com- 
mon cold. 

Every person that I have seen who had this form 



Prognosis. 105 

of this complaint has had attacks of the earlier forms. 
These facts would exclude all complaints that resem- 
bled it in the least. 

Dr. Wyman, because " its existence has been doubt- 
ed, and still is doubted by many, even by physicians, " 
has taken special pains to give the differential diagno- 
sis between this and a common cold and acute bron- 
chitis, and has also given the points of difference be- 
tween it and pneumonia and local inflammation of the 
eyes, but it seems to me that the physician who would 
mistake the one for the other must be a very poor 
observer indeed ; just as likely would an educated me- 
dical man confound an intermittent fever for a typh- 
oid fever. 

The diagnosis of each of the four forms have now 
been given, and it seems to me that a comparative 
study of the symptoms of all of these grades, from 
the formative stage through the final or Autumnal 
stage, must convince every one that this is but one 
complaint, an ailment that progresses in severity, 
starting from a common cold in the head, showing it- 
self but slightly in nasal catarrh, then assuming a lit- 
tle more severe character in the May and June forms, 
then still increasing in severity in the July form, and 
finally culminating in the severest form, the Autum- 
nal. 

THE PROGNOSIS. 

This will be goverened to some extent by the stage 
or form that afflicts the patient. In in the first or 
formative stage, nothing is easier to check, I fully be- 



106 Prognosis. 

lieve that this can be effected in patients not over fif- 
teen years of age, by hygienic measures alone. All 
cases not over thirty five years of age will be cured 
in one or at most two seasons of treatment, while 
with those over forty years of age, it may take a year 
or so longer. Every patient that takes good care of 
himself will in time completely recover. 

In this stage I would not recommend a surgical 
operation in any case, in either old or young patient, 
as the scar following the galvano-cautcry, or caustic 
acids, would be almost certain to be followed by a 
recurrence of inspissated masses to be blown out of 
the nostrils or hawked out of the throat, as soon as 
they attain sufficient bulk to impede respiration. 
These accretions will be just the size and shape of 
the scar. Besides being a source of very great annoy- 
ance it might — not always by any means — produce an 
unpleasant odor to the breath through the nostrils. 
Persistant employment of the spray producers will 
cure them. 

My experience in the treatment of the second stage, 
or May and June forms, leads me to say that they 
also will finally recover, but as the complaint has a 
stronger hold on them, a longer time for treatment 
will be required, and surgical interference may be 
needed to bring about the desired relief. But it must 
be kept in mind, as indicated above, that the smaller 
the operation, the better the ultimate recovery. The 
more confirmed the complaint, the longer will the pa- 
tient require fall and spring treatments to completely 



Prognosis. 107 

eradicate the primary or originating disease, namely: 
chronic catarrhal inflammation of the nasal passages. 

The same may be said of the third and fourth forms, 
that is, they will require more " chronic treatment " 
as it were, and surgical measures will be almost cer- 
tain to be required. The later in the year that the 
victims is attacked the longer the time will be required 
for its treatment and the greater will be the need for 
surgical interference. 

My experience in the treatment of the Autumnal 
form, justifies me in saying that the course I have laid 
down in this work is followed by satisfactory results* 



CHAPTER XI. 
Treatment; Medical and Surgical. * 

The treatment of pruritic rhinitis is divided into 
preventive, alleviative and surgical. 

The preventive treatment embraces the hygienic 
and therapeutic treatment for chronic catarrhal inflam- 
mation of the nasal passages, f As catarrhal disease 
has prepared the patient's nasal mucous membrane so 
as to render him liable to take the complaint, his ulti- 
mate recovery will depend upon his being treated for 
the primary disease fall and spring, or at such times 
of the year as he is most liable to take cold. 

ALLEVIATIVE TREATMENT 

The alleviative treatment is divided into therapeu- 
tic and hygienic, and the therapeutic into local and 
constitutional. The consideration of these divisions 
will be taken up in their natural course as they would 
occur in the treatment of a patient on arriving at 
one's office. 

The patient has suffered a few days or weeks tor- 

* Read before the St. Louis Medical Society, May 17th., 
1884, and published in the St. Louis Medical and Surgical 
Journal, Aug. 1SS4. 

f The reader is referred to the work on the "Hygiene and 
'Treat men t of Chronic Nasal Catarrh " by the author, pp. 473. 



Local Treatment. 109 

nient, and his nasal passages and throat are excessive- 
ly sensitive. In examining his pharyngo-nasal cav- 
ity, do not cause him to retch or cough ; while inspect- 
ing his nasal passages do not make him sneeze by 
either thrusting the nasal speculum too far up his 
nostrils or by pushing his nose upward or sideways. 
Be very careful to avoid doing anything that will cause 
him to sneeze. If a window or door of the ciHce is 
open, close it immediately, as even a slight draught 
of air will induce an itching sensation of the face, eyes 
and nostrils, which, if it lasts beyond half a minute, 
may bring on a paroxysm in full force. 

LOCAL APPLICATIONS. 

If a paroxysm does ensue, and indicates that it 
is going to last for several minutes, give the patient 
a little vaseline and direct him to anoint his face, neck 
head — if his hair is short — and hands ; rubbing the va- 
seline well into the skin ; have him put a silk handker- 
cheif over his head, and his hat over that; then direct 
him to pull off his boots and socks, and rub his feet 
well with vaseline, uncovering one at a time. It is 
altogether likely that his feet will be found to be damp 
with prespiration consequently quite clammy and 
cold. In this condition the vaseline will prove a very 
valuable remedy. 

This anointing and rubbing process, will materially 
shorten the paroxysms and lessened their severity. 
It will be well for the patient to repeat this course at 
such times as he may be attacked with a paroxysm. 



110 



Instruments for Making 



ll 



If ready to make a local application, give the patient 
the tongue depressor, tell him to place it well on his 
Fis. 1. 




Toxgue-Depressor.— The patient alone uses this instrument during 
examinations, applications an J operations. It should be placed well 
on t&e tongue, but not so far back as to cause a retching sensation. 

tongue, bnt not so far back as to cause him to cough 

or retch, then, having warmed the spray producer 

Fig. 2. 




Spray-Producers .—No. 1 . throws a stream in a horizontal direction ; 
applying the medicament to the fauces and tonsils, and by slight inhal- 
ation, the larynx and trachea are treated. No. 2, throws a stream at an 
angls of about 27° and is used to apply the medicament to the anterior 
nares as seen in Fig. 3. No. S, is not usually employed for treating 
pruritic catarrh, but may be used to treat the posterior wall of the phar- 
ynx as seen in Fig. 3. No. 4, throws a stream vertically, and treats the 
superior portion of the pharyngo-nasal cavity. No. 5, throws a stream 
at an angle of 45° and is made to enter the poterior nares, also shown 
in Fig. 3. 

( 'No 4 ), half fill its bowl with plain vaseline and 
about 5 grains of the following : 



Local Applications. 



Ill 



I£. Vaseline gij. 

Eucalypti ext. (Sander & Son ; Sanharst 
Australia.) min x. 

Mix while cold. 

Fig. 3. 




[ *to<<iCKK, t 



Antero-Posterior Section of the Head, showing the combined di- 
rection of Spray Producers Nos. 2, 3, 4 and 5 in the local treatment of 
the pharyngo-nasal and nasal cavities . No. 2 is introduced into the 

anterior nares . 



112 Local Applications. 

The mixture, after it is placed in the spray pro- 
ducer, should be made so hot, that after it is tempered 
with the cold air from the instrument, the spray will 
produce a warm, pleasant sensation. Place the point of 
the spray producer just behind and below the pendent 
velum and alternately to each side of the uvula; throw 
the spray up behind the soft palate, gently at first 
(never using a pressure exceeding 7 fibs, to the square 
inch), observing closely the part of mouth that is be- 
ing operated upon jalso watch the actions of the face 
and eyes. All these parts must be seen at the same 
time, a practice that cannot be successfully acquired 
without much experience. 

Should the patient's throat begin to contract or his 
eyes close, or there occur any other sign that indi- 
cates contraction of the fauces, instantly cease throw- 
ing the spray, withdraw the instrument, and at the 
same time request him to take the tongue depressor 
out of the mouth. All this must be done, if possible, 
before he retches. At once request him to clear his 
throat. This act will rest him, as holding one's mouth 
open for two or three minutes is a little fatiguing. 
Then continue to make other application until all the 
remedy is thrown into the pharyngo-nasal cavity, 
keeping in mind these directions. 

If the medicament has been made warm and 
thrown to the parts indicated, the patient will volun- 
tarily say that he experiences a sensation of relief and 
smoothness in his throat; and if asked to locate the 
place where he feels the relief, he will at once place 



Local Applications. 11& 

* 
his fingers over and below the larynx ) many of them, 

especially those who have a tickling cough in the lar- 
ynx that has lasted for a few weeks, will place their 
hand on the upper portion of the chest. 

Next make an application by means of the spray 
producer No. 5, applying with it the same remedies, 
and introducing the point of the instrument in the 
same way as with the No. 4, using the same precau- 
tions. 

If the patient is not conscious that the stream from 
the instrument is going into his nostrils, it indicates 
that the mucous membrane is in quite an anaesthetic 
condition and that the inflammation is quite chronic, 
consequently it may be slow in yielding to tho 
treatment. 

Third, make an application to the fauces while the 
patient is slowly and deeply inhaling, using the 
spray producer No. 1. By this instrument the same 
vaseline compound is applied, with the addition of 
three to five drops of the following: 

IjL Pinus Canadensis (Kennedy's) grs. iij. 

Glycerinse (Price's) 3 ij. 

Acidi Carboliei or. ss. 

Ol. Galtherise gtts. v. 

Aquse Ferv 3 vj. 

M. 

This makes a pleasant mixture and has a very 
soothing effect on a throat and soft palate made sore 
by coughing. 

I usually use five drop3 of the Pinus Cand. comp., 
during the first three treatments, then four drops for 
the next three. After this, using one and two at each 



114 Local Applications. 

succeeding treatment. If too much of this astringent 
is employed, the patient will complain of a slight 
soreness in the throat on swallowing. 

Do not make an application to the nostrils in 
front, because the force of the air will be almost cer- 
tain to excite sneezing, which is very undesirable. 
After some ten or twelve treatments, the excessive 
sensitiveness of the anterior nares may be reduced, 
then a very gentle spray of the vaseline and eucaly- 
ptus may be thrown into them. 

The spray producer No. 5 is the most important in- 
strument because it throws the remedy to the re- 
gions, the middle and superior turbinated processes, 
where the inflammation is most severe, this loca- 
tion being the site of origin of the primary disease, 
the chronic catarrhal inflammation. It is also the 
most dinicult instrument to handle, because the stream 
of spray that issues from it is liable to strike the 
upper surface of the soft-palate and thus cause con- 
traction of the faucal muscles. 

If the pressure of the air that is used for making 
the spray is too great, the application may give rise 
to a paroxysm of sneezing, an effect that is quite un- 
desirable; most patients can bear an air pressure of 
7 lbs to the square inch, but some can only endure 
4 lbs. 

The effect of these applications, when judiciously 
made, will be very agreeable to the patient, relieving 
him at once of many of his most annoying symptoms. 



Application of Electricity. 115 

Indeed, so marked has been the relief experienced by 
many of my patients, that some of them, have made 
remarks as ungracious as the following: " I guess 
this attack will not be very bad anyhow." 

ELECTRICITY. 

This remedy is a valuable adjuvant, one that should 
be employed in every case, especially toward the lat- 
ter part of the treatment I have not been successful 
in the employment of the Faradic current, but with 
the galvanic current, the patient will at once state 
that he experiences beneficial effects. 

It requires from 6 to 18 Leclanche cells to produce 
the desired effect. I apply the negative pole (cathode) 
to the lower end of the sternum, and the positive 
pole (anode) to the seventh cervical vertebra. * By 
this application all five of the special senses may be 
excited. The sense of taste is always excited if the 
application is properly made; it is known by a metal- 
lic taste being experienced in the throat and mouth, 
proving that these two organs are under the influence 
of this agent. An application that does not in this 
way excite the sense of taste is inefficient. The posi- 
tive pole may sometimes be applied with marked 
benefit over the nose and cheeks, care being taken to 
employ just sufficient strength of current to be slightly 
felt. 



*. This is called Central Galvanization by Beard and 
Rockwell. 



116 Constitutional Treatment. 

The length of lime that the electricity is applied 
should not exceed three minutes. One minute is the 
length of time that I usually employ it on new pa- 
tients, watchfully lengthening the seance to the full 
time, three minutes. Instantly reversing the current 
for a few times, as well as interrupting it, is frequently 
productive of good results. I always make the ap- 
plications after completing the local treatment with 
the spray producers. 

constitutional treatment. 

All of these patients are habitually constipated, and 
their renal secretions are usually scanty, besides this, 
they are in a condition of body that easily becomes 
exhausted, and many of them are in a state of contin- 
ual weariness, therefore a laxative, a diuretic and a 
tonic are indicated. The bowels should be main- 
tained quite open ) at least two operations each day 
will be beneficial, for a week or two. 

Ten grains of quinine should be taken each night 
on going to bed, This should be continued every 
night until the paroxysms are reduced to about 50 
per cent, of their usual severity then seven to five 
grains maybe a sufficient quantity. Many patients 
think that such doses would keep them awake, but 
in cases that were not severe, the contrary was the 
effect. I have sometimes added to the quinine, five 
grains of bromide of potassium with excellent results,, 
obtaining refreshing sleep. 



Hygienic Measures. 117 

Special Hygiene of Pruritic Catarrh {hay fever, 
etc. ) * 

It is as prepostrous to expect to even alleviate a 
patient afflicted with pruritic catarrh without strictly 
following the rules of hygiene, as it would be to main- 
tain a ship dry with a leakage in its hull or a man 
sober while continually imbibing large quantities of 
alcoholic drinks. 

protecting the head, the hair. 

If a patient who has suffered from annual attacks 
of this complaint for about five years, and whose head 
perspires freely, should make the mistake of having 
his hair cut so short that it cannot be parted, he will 
soon learn, to his sorrow, that but little can be done 
to lessen the severity of his paroxysms, until his hair 
again grows. A cap may afford him some protection 
but because of its too frequent removal, it will not 
take the place of the lost hair. A properly construc- 
ted wig will come nearest in doing this. 

WIGS, HEALTHFUL TO THE BALD-HEADED. 

A large proportion of persons who are afflicted 
with pruritic catarrh are bald-headed, and the scalp 
of very many of them perspire profusely on the 
slightest exertion. With such, a very slight draught 
of air is sufficient to bring on a paroxysm of sneezing. 
An acquaintance, who had the misfortune to be quite 

* Read before the St. Louis Medical Society, May 17th, 
1884. 



118 Protection for the Head. 

bald, informed me in 1872 that he cured himself of 
his " hay-fever " by wearing a wig. He had suffered 
from this complaint for a few years, and observed 
that he was most liable to sneeze when his head was 
bathed with perspiration. If at such times he wiped 
his head with a handkerchief that had been wet, 
it produced a cold, chilly sensation to his head, and 
always caused sneezing ; if he used a warm hand- 
kerchief he did not sneeze. He had a relative who 
was a wig maker, and. who advised him to wear a wig 
to prevent him from wiping his head so often. It 
took him some weeks torture by the disease before 
his pride — an exceeding foolish one — gave way. 
He felt an improvement on the first day of wearing 
the wig and did not have an attack after that season. 
Of course he continues to wear the wig. Besides re- 
lieving him of his annual attacks of pruritic catarrh, 
he was relieved of headache also, a complaint that he 
had been subject to for years before his attack of 
"hay-fever." 

I strongly urge all my bald-headed patients, whether 
afflicted with pruritic catarrh or with common chronic 
nasal catarrh, to wear a wig. The hair should be let 
grow until it is long enough to nearly touch the coat 
or dress collar; it should not at any time be much 
shorter or longer on any person, male or female. 

The beard should be allowed to grow until it forms 
a good protection to the throat and neck. Shaving 
is a flagrant violation of one of the laws of health. 



CliO'lHING. 119 

HATS AND CAPS. 

The best hat for male patients is the soft hat. 

A light skull cap should be worn day and night 
when the patient is in the house. It is not necessary 
to have a different cap for night wear, unless a 
warmer one was required at night, for the protection 
of the head is equally essential during all hours of 
the day and night. 

All of these patients, male and female, perspire 
very freely about the head, and while the scalp is thus 
covered with moisture, even a slight draught of air 
will, in a few minutes, reduce the temperature of the 
surface fully 20°F. which in all probability, will be 
sufficient to produce a paroxysm. The cap is inten- 
ded to prevent this sudden lowering of the tempera- 
ture, not for the purpose of keeping the head warm. 

Female patients should wear a silk hood day and 
night, it need not be very heavily quilted. 

Those patients who do not require the inunction of 
the whole body with vaseline, may require to have 
the face, neck, hands and feet anointed with vaseline, 
as they retire for the night, as described in the section 
relating to local treatment. 

CLOTHING. 

Patients of both sexes should wear thin stocking- 
knit, cotton and wool mixed, vest and drawers, and a 
heavy suit of pure flannel over them. The advantage 
of wearing cotton next to the body, is that it ab- 
sorbs the perspiration, thus preventing a cold, chilly 



120 Hygienic Measures. 

sensation, should the body be exposed to a draught of 
air. Some of my patients have felt the necessity of 
wearing a third suit consisting of heavy flannel even 
on hot days, and claimed that they did not suffer in 
the least from excess of heat. This class of patients 
and all whose nasal passages are affected with catar- 
rhal inflammation require a large amount of clothing 
and they bear it with great comfort. 

INUNCTION OF THE BODY. 

This is very frequently productive of marked bene- 
fit. The room in which the inunction is to be made 
should be kept quite comfortable. Yaseline is the 
substance to be used. It should be rubbed on by 
means of a flannel cloth made hot over a lamp. The 
clothing should be removed to the waist, and the body 
well rubbed, occupying about fifteen minutes time, 
then the clothing should be replaced, and that of the 
lower portion of the body removed, after which this 
part also should be well anointed, occupying about 
the same length of time. Some patients are remark- 
ably fond of this operation and spend an hour and 
even longer in its performance. 

THE FEET. 

Male patients should wear boots, females high shoes. 
Two pairs of stockings should be worn; the pair next 
the feet should be cotton and the other woolen. 

If slippers are to be worn, a pair of heavy woolen 
stockings should be drawn on over the stockings al- 
ready on the feet. 



Hygienic Mea&ures. 121 

Females must not wear elastic garters. In order to 
maintain the hose in place, they should be pulled on 
over the thin underdrawers, and held by four elastic 
straps, each of which has brass loops on each end, so 
formed as to securely retain the hold on the drawers 
and the top of the hose. In this way the circulation 
of the blood in the limbs is not impeded. 

THE SLEEPING ROOM. 

The sleeping room should be large, and well swept 
and dusted every day, it should face the Scv.th and 
East if possible. From morning until 1 p. m„ all the 
windows and doors should be left wide open ; after 
that time they should be all closed up tight and the 
sunlight be excluded to almost total darkness. A piece 
of ice, weighing about 10 lbs., hung up about 6 feet 
high, in the middle of the room, will lower the temper- 
ature of the air to a pleasant coolness, and it will con- 
tinue so during the whole night. Some might think 
that this would make the air of room too damp, but 
such is not the case. 

If the ice melts too rapidly so that the air is made 
too cold, the ice may be covered with a piece of cot- 
ton or woolen cloth, with the woolen, the ice will melt 
more slowly than with the cotton covering. A swing 
to hold the ice may be made of a common towel, 
stretched and held by the four corners. This leaves 
the ice exposed to the downward current of warm 
air, which, as soon as it strikes the ice is lowered 
in temperature, continues in its course to the floor, 
forming the lower stratum of air in the room. 



122 Hygienic Measuees. 

The water from the ice may be caught in a bucket 
or other receptacle as it drops from the towel. 

SLEEP. 

The patient should sleep between blankets, but not 
on feathers or old moss or old hair, a cotton mattress 
is the best. If a cotton mattress is not used then a 
heavy cotton quilt should cover the bed mattress. It 
will be well to have the pillows made of cotton. 

Annointingthe face, neck, hands and feet with vase- 
line, just before retiring is quite refreshing, because it 
is cooling. 

The " catarrhal season " should be slept away if pos- 
sible, but it is not best to sleep so much during the 
day that the night will be passed in wakefulness. If 
the patient cannot sleep sufficiently long at night, an 
anodyne should be given, but as a usual thing the ice 
and quinine produces refreshing repose. 

THE DIET. 

A good, nourishing diet is advisable. Everything 
that the patient thinks that may disagree with him, 
and all those articles knows to disagree with him, 
should bo avoided. Going to bed very hungry may 
prevent a good night's sleep. Drinking water is 
always healthful. One to two teacupfulls of hot water 
as soon as the patient rises from bed in the morning, 
or if convenient, before rising, is frequently conducive 
to good digestion. Milk, if taken after dinner, is lia- 
ble to induce a cough by its causing the mucus in the 
throat to become Quite thick and adherent. 



Hygienic Measures. 123 

exercise. 
Many of these patients suffer from palpitation of 
the heart when they take exercise, bat some gentle 
exertion, even to the extent of inducing a slight per- 
spiration, is quite beneficial. As a general thing, the 
avoidance of sunlight, dust, smoke and other irrita- 
ting agents that float in the air is the most conducive 
to comfort. Walking in a close, darkened room, in 
which a piece of ice is hung, to keep the temperature 
fully 10° F. to 20° F. below the outside temperature, 
is usually quite refreshing. 

TO BE AVOIDED. 

Sufferers from this complaint should not bathe; 
should not smoke, chew or snuff tobacco ; should not 
drink beer, wine, whisky, brandy, gin or any bever- 
age that contains alcohol; should not be out in the 
night air, should not allow themselves, under any 
circumstances, to become angry. The disease has a 
tendency to make one irritable, but this condition of 
mind must be controlled. A fit of anger will be al- 
most certain to induce a fit of sneezing. Every victim 
of this complaint can, if he chooses, cultivate a habit 
of becoming angry, to his own discomfiture, or of 
exhibiting a disposition of patience. Coughing and 
sneezing must be avoided if possible. The former 
may many times be controlled to almost complete 
suppression. Handkerchiefs that have become wet 
from nasal secretions and tears, should be put out of 
the room. If the expectorations are very profuse, a 
spittoon filled with dry earth should be kept in the 
room and new earth put in it every morning. 



124 Conservative Surgery. 

Surgical Treatment. 
Local medication and hygienic measure being com- 
pleted, attention will now be given to harsher meas- 
ures, which are to be employed in case the milder 
course has failed to give the desired relief. Before 
giving the description of the surgical operations, I 
feel it my duty to make a few 

REMARK8 IN FAVOR OF CONSERVATIVE SURGERY. 

Immediately successful results are always desirable 
in the healing art. Nothing captivates the physician 
and patient like an operation that promises immediate 
relief, by it days of uncertainty and suspense are to 
be banished and in their place, the victim is to quick- 
ly enjoy life free from torment. Especially is this re- 
sult satisfactory in the highest degree, when the relief 
relates to a complaint that all our old and respected 
authorities have acknowledged was incurable. But 
with this grand advance in Ehinology, we must not be 
unmindful, that while the removal of diseased tissue 
is followed by marked relief, yet there is danger that 
this benificent operation may be employed too fre- 
quently, ?nd in cases where it will be certain to do 
lasting harm. 

Suppose a man, suffering from a violent toothache 
should visit one of our cheap " tooth-pulling w shops, 
and have it extracted, without first informing himself 
as to the possibility of its being saved for future val- 
uable service; every one would at once pronounce 
.him exceedingly foolish for thu3 impatiently sacrifi- 



Conservative Surgery. 125 

cing so important an organ. No doubt he would, in 
this way, be relieved of the pain in his tooth in a very 
much shorter time, than even an expeirenced dentist 
could have relieved him while saving his tooth, but 
what is to be said of the loss he has sustained? Is the 
loss of a tooth of so small a moment that it is not to 
be taken into consideration? In other words: is relief 
of the annoyance of an aching tooth in the quickest 
possible way the best under all circumstances ? 
" Tooth-pullers" might say yes, but no dentist would. 

In this dental case, we have almost a complete par- 
alell to the operative method for the relief of pruritic 
catarrh. As there are numerous cases in which it is 
far better to extract an aching tooth, than try to save 
it, so are there numerous cases of pruritic catarrh in 
which it is far better to remove the offending mem- 
brane, than to endeavor to relieve the complaint by 
treating the originating inflammation; at the same 
time there are many aching teeth that should not be 
extracted, so are there many cases of pruritic catarrh 
that can be cured completly without any other treat- 
ment than the mildest measures for removing the 
chronic catarrhal inflammation of the nasal cavities. 
The mucous membrane of the nasal cavities, like the 
teeth, is a veiy valuable organ, and is essential to the 
welfare of the patient. 

Let ns retain all the benefits to be derived from 
surgical operations that will afford immediate relief 
of this complaint, but, at the Fame time, let us be care- 
ful not to entail a lasting injury by a rapid method, 



126 Important Facts about Cicatrices. 

when the same object can be attained by a slower 
method that would preserve the mucous membrane 
for future use. 

I believe that every case of pruritic catarrh can be 
relieved of the pruritic symptoms at once by the 
"destructive process", but I do know from experience, 
that many cases can be cured without desroying the 
mucous membrane — without committing irreparable 
damage to this important organ, the loss of which 
may cause the patient to lead a life of unhappiness, if 
not of torment from an ozenic condition of the nasal 
cavities, that sometimes follows such operations. 

I do not wish to act the part of an alarmist, but de- 
sire to give some wholsome warning, that 1 am cer- 
tain will be beneficial to the profession and their pa- 
tients. 

IMPORTANT PACTS. 

There are several very important facts that should 
engage the careful considertion of every physician 
who contemplates performing an operation on the 
nasal cavities, namely : 1st., a cicatrix follows every 
application of the galvano-cautery, nitric acid, chro- 
mic acid, etc; 2nd., this scar membrane is not mucous 
membrane; 3d., this scar surface is always dry; 4th. 
the nasal secretion flowing from mucous surfaces sup- 
erior to it is certain to lodge on this dry spot, and 
there become inspissated and be the occasion of sev- 
eral very annoying symptoms. 

Before inspissation takes place, the mass becomes 
decomposed, and if the muco-purulent secretion is 



Scar Tissue and its" Effects. 127 

profuse, it will affect the breath unpleasantly, a very 
serious matter if the patient is a young woman. With 
the decomposition, it acquires an acid properly, which 
will cause so much irritation at the place of lodge- 
ment, that the patient will not desist picking and 
blowing the nose to free himself of it. The blowing 
not unfrequently resulting in ear complications, the 
secretion in the pharyngo-nasal cavity being forced 
up the Eustachian tube and into the tympanum, 
where it may originate tubal and middle ear catarrh. 

I have seen, during the spring of this year (1885) 
five persons who had the formation of crusts in the 
nostrils none of whom had such formations previous 
to their being operated upon by the galvano cautery. 
Such cases are veiy much more difficult to cure than 
the so-called atrophic catarrh. Indeed three of these 
cases were pronounced atrophic catarrh by a physi- 
cian previous to their calling on me. 

1 account for the formation of this inspissated col- 
lection in this way: The scar tissue, that follows all 
destructive applications, cannot perform the functions 
of mucous membrane ; as it has not a single mucous 
gland in it, consequently it must always remain dry, 
unless moistened by contiguous mucous membrane. 
Being always dry, secretion that lodges there, remains 
there, the heat of the cavity evaporating its watery 
portion, causing inspissation. 

The point I wish to make is this : the less scar 
tissue there is formed in teie nasal cavities, the 
better for the future welfare of the patient. 



128 Cases to Operated upon. 

If it is found upon trial that the treatment for 
chronic catarrhal inflammation will not relieve the 
patient of the pruritic nasal symptoms, then operate,, 
but not before; no physician is justified in resorting 
to severe treatment before he has proved that a 
milder course has been ineffectual. 

THE KIND OF CASES TO BE OPERATED UPON. 

As indicated in the closing paragraphs of the last 
chapter, page 106, only the most chronic cases, prin- 
cipally those affected with the middle and late forms, 
will require surgical treatment. I have not yet oper- 
ated on a case of the May and June form, and quite a 
number of the July and Autumnal forms have recov- 
without surgical interference. 

My method of ascertaining who will require opera- 
tive procedure, is to treat by the spray producers 
every case for a few days, giving from five to fifteen 
treatment. From the effect of these applications, I 
judge whether or not the case will require severer 
measures. It is seen that I operate on a few patients 
as possible because I fear the effects that will follow 
the formation of scar tissue in the nasal cavities. I do 
not wait until the pruritic season as passed away, but 
operate as soon as I find that the spray producers will 
not cure the complaint. 

RELIEF BY SURGICAL MEASURES. 

This consists in the removal of the diseased, hyper- 
sestheic mucous membrane that covers the turbinated 
processes and portions of the septum nasi. This is 
done by means of Jarvis's wire snare, or by caustics,. 



Locating the Diseased Membrane. 129 

such as chromic, acetic or nitric acid, or by the galvano- 
cautery. The galvano-cautery and Jarvis's snare are 
considered the most reliable. Dr. J. A. Stucky of Lex- 
ington, Ky. uses, with excellent results, chromic acid. 
I have grasped the sensitive portions of the membrane 
with a slender, but strong pair of forceps, maintaining 
the hold on the membrane for two or three minutes, 
first spraying the parts with a 2per cent, solution of 
cocaine. The result was quite satisfactory. 

LOCATING TILE DISEASED MEMBRANE. 

In locating the hypeneslhetiu spot or spots, I em- 
ploy, if possible, a small reflector (Fig 4.) if it can 
Fig. 4. 



Anterior Nasal Mirrors.— The mirrors are represented full size 
The handles are five inches long. The desired angle may be given to 
each mirror by bending tne wire handle near the glass. 

be passed into the anterior nares without producing 
much if any irritation, using, at the same, a nasal 
speculum. I then insert a probe, bent slightly at the 
point, and ascertain according to the method employed 
by Dr. Roe, of Eochester N. Y. ( see appendix ) the 
location of the most sensitive spot known by the pa- 
tient experiencing a burning sensation. This spot is 
then touched, after it has been anesthetized by cocaine. 
This valuable anaesthetic renders these surgical pro- 



130 Galvano-Cautery. 

cedures comparatively painless during the time of the 
operation, but does not prevent considerable pain for 
several hours afterward. 

APPLICATION OF THE GALVANO-CAUTERY. 

Every one has a favorite manner of applying the 
galvano-cautery. Some allow the platinum to become 
almost white hot before passing it into the nasal cav- 
ity. I did this on several occassions to my patients 
great detriment, the radiating heat being so great as 
to cause acute inflammation of the whole cavity and 
great swelling of the face. The electrical energy 
should be sufficient to make the platinum white-hot 
in one second of time. Of course if the current was 
allowed to continue, the wire would be burnt in about 
three or four seconds, but when the electrode is laid 
on the tissue, this keeps the wire from becoming suffi- 
ciently hot to be destroyed. 

- 'I prefer to place the electrode on the spot to be 
^cauterized, and then make the connection with 
my foot, never using my finger or thumb for mak- 
ing connection, as this would necessitate holding 
the instrument so firmly in my hand that I could not 
be certain of the degree of pressure I was making on 
-the part being burned. 

Immediately on the withdrawal of the electrode, I 
spray the cavity with spray producers JSos. 2 and 5 
(see page 111.) employing the vaseline comp. given 
on page 111. This will have a soothing effect, but if 
the patient still complains of the distress from the 
burning, apply the oleate of cocaine. This is an ex- 



Jarvis's Snare. 131 

■ccllent preparation, and produces a much more last- 
ing effect than the solution. The strength I now 
employ is 5 per cent. 

The next day, the patient should receive the regu- 
lar treatment with the spray producers. Usually the 
first application of the electricity has a marked effect, 
reducing the pruritic symptoms. 

As soon as the patient can endure a second appli- 
cation of the cautery, it should be applied. Gener- 
ally one and two applications a week can be borne 
without great discomfort. 

Constitutional treatment should be given while the 
local measures are being employed. 

JARVIS'S SNARE. 

I prefer this instrument to the galvano-cautery, be- 
cause it can be employed to remove even an exten- 
sive hypertrophy of the turbinated processes without 
leaving a large cicatrix, certainly not the one-tenth 
of the size of the portion removed. 

After engaging the loop of the snare around the 
hypertrophy, I tighten the nut sufficiently to prove 
that the snare has a hold. I then direct the patient 
to take hold of the instrument with his left hand 
and turn the nut with his right hand. This 
he should do so as to cause but little pain. It 
generally takes about half to three-quarters of an 
hour to cut off a large hypertrophy. When the instru- 
ment has cut itself out, if the patient does not blow 
his nose — which he should not do — the removal will 
be made without the loss of blood, or at least with 



132 Chromic Acid. 

very little ; but best of all, the size of the scar left is- 
about the size of a large pin's head. Of course, coca- 
ine should be applied before the snare is adjusted. 
This method of removing diseased tissue pleases me 
very much. I feel like thanking Dr. Jarvis every 
time I use his instrument, as with it I preserve my 
patient from the evil effects of a large cicatrix. 

CHROMIC ACID. 

I have used this acid a few times, but probably did 
not apply it just in the right manner. The reader 
will be pleased with the success that Dr. J. A. Stucky y 
of Lexington, Ky., has had with this powerful agent. 
His views and experience may be seen in full in the 
appendix. 

One of my patients, a delicate lady, was so severely 
affected by pain in her left ear, occasioned by the 
effect of chromic acid applied in the left nasal eavity r 
that I was obliged to perforate the membrana tym- 
pani to give her relief. 

I applied the chromic acid by means of a probe. I 
heated the point of the probe and touched it to a crys- 
tal of the acid, which instantly melted and coated the 
probe. I then touched the hypertrophied membrane 
with the probe, aided by the anterior nares reflector 
inserted into the cavity from the front. Two appli- 
cations had been made, but these did not occasion very 
great disturbance. I may have held the acid on the 
parts too long, and so produced a more lasting im- 
pression than was required. A 2 per cent, solution of 



Posterior Xares. 133 

•cocaine was applied two separate times before the 
acid was used. 

NITRIC ACID. 

I employed nitric acid but one time. The distur- 
bance occasioned by its application was so great that 
I think that I will not use it again. 

POSTERIOR NARES. 

If the posterior portions of the turbinated proces- 
ses or the septum nasi are to be inspected or oper- 
ated upon, I hand the patient the tongue depressor 
{Fig. 1) and direct him to hold his tongue down 
with it, using his left hand. If the space between 
the posterior wall of the pharynx and the soft palate 
is sufficiently large, I place the pharyngeal reflector 
(Fig. 5.) back in the fauces to get a reflection of the 
Fig 1 . 5. 



Phaktxgeal Mirror.— By pressure on the level rn the handle 
the mirror may he made to tate any desired angle, thus reflect- 
ing the posterior, superior and anterior surfaces of the pharyngo-nasal 
cavity, while rotation on its axis reflects the lateral surfaces. 

posterior extremities of the inferior and middle tur- 
binated processes and the septum nasi, using my left 
hand, leaving the right hand for the manipulation 



134 



Drawing Soft Palate Forward. 



of the diagnostic probe, the electrode, the Jarvis 
snare, or the chromic acid probe. 

If the velum hangs too close to the posterior wall 
of the pharynx, I hook the pendent portion with 
the spreading soft palate retractor (Fig. 6.). Before 
Fis:. 6. 




Soft Palate Retractor. — A, Lever to seperate the arms. B, The 
soft rubber band that closes the arms and holds the uvula out of the op- 
erator's way. C, The lever that raises the wedge. After the instru- 
ment is is introduced behind the velum and the arms spread by the 
lever A, then then the wedge retains them in position. 

drawing the palate forward, I spread the limbs of 
the instrument a little, and then draw it slightly out- 
ward. I then lift the right hand of the patient to 
the handle of the instrument and direct him to draw- 
it as far forward as he can without causing unpleas- 
ant sensations. The patient can hold the instrument 
very much better than an assistant, as he knows 
how to control it so that it will not cause him to 
retch or occasion pain. 

The reflection from the pharyngeal mirror will 
assist the operator in locating the sensative spots,, 
and in adjusting the Jarvis snare. 

In making all caustic applications to these parts I 
employ the same methods. 



APPENDIX. 



As the most of this little book was written one, 
two and three years ago, I could not embodie, with- 
out rewriting each chapter, the opinions of many of 
the late writers on this subject; but as the views of 
many of them are important and the information very 
valuable, I have concluded to place them all together, 
in the form of an appendix, giving those first that 
were published first. 

Extracts from Dr. Wm. H. Daly's Article. 

Dr. "Wm. H. Daly of Pittsburg, Pa. read a paper 
before the American Laryngological Association in 
1881, and published in the Archives of Laryngology,. 
April, 1882, " On the Eelation of Hay Asthma and 
Chronic Xaso-phayngeal Catarrh." 
He says: — 

"Let me ask that patients suffering from hay asth- 
ma be thoroughly inspected, and if evidence of chronic 
inflammatory naso-pharyngeal disease and its re- 
sultant derangement of sensibility and secretion exists,, 
treat it, losing sight, as far as possible, of the exciting 
or atmospheric cause, that can in no wise be removed 
without removing the patient. 



136 Dr. Daly's Paper. 

" If hypertrophic enlargments of the mucous mem- 
brane in any part of its distribution are found, reduce 
them or remove them entirely. 

" If polypi or polypoid growths are found, remove 
them, cauterizing thoroughly the bases of the 
growths. 

"If there is chronic disease of any kind whatso- 
ever, put the parts in order, and thereby enable them 
to withstand the exciting influence of the next recur- 
ring crop of bacteria. A preternaturally irritable 
condition of the parts, from any disease whatsoever, 
will render them liable to respond to the effect 
of influences that would be entirely innocuous if 
applied to healthful tissues. If we resort the diseased 
tissues to a healthful condition, and hay asthma re- 
curs, then we are warranted in considering the indiv- 
idual case a neurosis, and not otherwise. 

a The histories of the following cases show beyond 
doubt that the annually recurring attacks of hay asth- 
ma were not so much the result of the mere presence 
of bacteria in the atmosphere as the fact that these 
bacteria had their peculiar effects upon parts rendered 
susceptible to their irritating influences by chronic 
local disease of the naso-pharynx. " 

He then gives the history of several very interest- 
ing cases, the result of whose treatment fully substan- 
tiates all that has asserted in the above five paragraphs 

His first case consulted him iu December 1878, and 
found that he had hypertrophic growths. 

"* * Destruction of the growths was accomplished 
with the gal vano- cautery, and treatment during the 
next three months resulted in a great diminution of 
the hypersensibility of the nasal mucous membrane. 
The question was later asked, as to what would be 



Dr. Daly's Paper. 137 

the prospect of immunity from the expected attack of 
hay asthma. While giving him no encouragement, I 
advised him to wait and see. The dreaded 15th of 
June, 1879, was passed at home. The summer and 
autumn passed also, and the spring and summer of 
1880 — 81 were all passed at home, without any re- 
currence of hay asthma." 

He closes his interesting and valuable paper with 
three following the conclusions: 

"1st. That in a proportion of cases there is an in- 
trinsic condition of local chronic disease upon which 
the exciting cause acts with effect. 

" 2d. Without this intrinsic local disease the excit- 
ing cause is innocuous. 

" 3d. The patients believed they were onl}- slightly 
if at all, affected with naso-pharyngeal disease of a 
chronic character." 



188 Dr. Eoe's Paper. 



Extracts from Dr. Boe's Paper. 

Dr. J". O. Eoe of Bochester, 1ST. Y. has been success- 
ful in troating this ailment by surgical means. In 
the fall of 1879 he operated on a patient of his, who 
" had been a sufferer from hay-fever at least twelve 
years." Dr. Eoe removed the turbinated hypertro- 
phy with a galvano-cautery. 

In speaking of the result of this operation be says : 

"Greatly to his, and also to my surprise, he was not 
attacked by hay-fever during the following summer; 
and, as he informed me a short time ago, he has been 
entirely exempt from it during each summer since. "" 

From the following quotations, taken from Dr. 
Eoe's second article, read before the Medical Society 
of the State of New York, Feb. 1884, his method of 
procedure is seen : 

"In the treatment of hay-fever we should first deter- 
mine, by a careful exploration of the nasal chambers, 
the exact nature of the conditions which have been 
the exciting cause of the hyperesthesia. Each parti- 
cular spot which is especially sensitive should be loc- 
ated, and receive thorough and careful treatment until 
this sensitiveness is removed and no sensation of hay- 
fever is experienced by the patient when these regions 
are touched. This hay-fever sensation is unmistakable 
by the patient, for on touching these regions, however 
lightly, a burning sensation is felt in the nostril, as if 
the probe were heated, and is attended by the usual 
reflex phenomena. 

" When hypertrophied turbinated corpora caver- 
nosa are the seat of the sensitive region, they should 



Dr. Koe's Paper. 139 

"be throughly removed. When this region is the seat 
of the sensitiveness, though there is no well-marked 
lrypertrophy of the turbinated bodies, sufficient tissue 
should be removed to distroy the diseased and sensi- 
tive terminal nerve filaments and to obliterate the en- 
larged blood-vessels. Redundant and hj*pertrophied 
tissue is best removed with Jarvis's snare, although 
caustics, such as acetic, chromic, or nitric acid, maybe 
employed. For the distinction of the deeper plexuses 
of vessels, the galvanic cautery is by far the most effi- 
cient. It is also the most efficient means of removing 
the sensitive regions on the septum and other portions 
of the nasal chambers. For the latter purpose, a very 
small point should be used, so as to enable the operator 
to limit the cauterization entirely to the diseased tissue, 
and, by using a very small point, but little pain is oc- 
casioned. 

"All obstructions to the nostrils other than hyper- 
trophic tissue should be removed, and also all abnor- 
mal conditions of the passages, whether they be suffi- 
cient to cause obstruction to the chambers or not,, 
should be corrected. 

"In all these cases it is of special importance that 
there should be no points of contact between the tur- 
binated bones themselves or the turbinated bones and 
the septum, even though there be no obstruction 
whatever to respiration. Spiculae of bone are often 
found projecting across like a spur and exciting irri- 
tation and producing thickening of the opposite sur- 
face. This condition is more often found between the 
middle and superior than the inferior turbinated bone 
and the septum. 

"Afterward, when all offending tissue has been 
removed, local medication should be made to the 
nasal passages until the parts are healed and the 



140 Dr. Eoe's Paper. 

chronic rhinitis cured, and the special irritability and 
hyperesthesia has disappeared from every portion 
that is shown by the exploration with a probe to be 
abnormally sensative. 

"The time when these radically curative measures 
should be instituted is, my observations lead me to 
believe, when the patient is free from the affection, and 
in time to allow thorough healing of the parts before 
the time of the expected attack, although, if neces- 
sary, it may be begun during the attack. 

"It is also advisable and even necessary (where 
there is a doubt as to the sufficiency of the treatment) 
to examine the patient from time to time during the 
haj^- fever season to observe if any portion of the 
nasal mucous membrane becomes irritated that has 
before been overlooked. If so, it should then receive 
prompt attention, and the diseased portion be thor- 
oughly removed. 

"The practical outcome or result of this method of 
dealing with hay-fever is, after all, the most interest- 
ing evidence as to its value. Of the five cases which I 
reported to the society last year, four have been acces- 
sible, so that I have been able to determine the re- 
sult in these." 

The following case will be read with interest and 
instruction : 

"Case VI. — J. E., aged twenty -seven, a stout, well- 
developed man, was referred to me March 9, 1883. 
He had had hay-fever for eight yeai*3 very severely, 
his attacks coming on about August 10th and con- 
tinuing until frost came, and being attended with 
more or less asthma. During the remainder of the 
year he had more or less catarrh and frequent colds 
in the head, with marked stoppage of the nostrils. 



Dr. Eoe's Paper. 141 

When free from colds, his nostrils were clear and un- 
obstructed. The inhalation of dust or any marked 
irritant at any time would cause sneezing and tempo- 
rary stoppage of them. 

" Examination showed moderate general thicken- 
ing of the mucous membrane of both nasal passages, 
but the turbinated bodies were not noticeably hyper- 
trophied, nor were there any bony obstructions. On 
exploration marked sensitiveness was found all along 
the inferior and middle turbinated bones, especially 
at the posterior end, giving rise to the' characteristic 
sensations of hay-fever. A similar sensitive region 
was found along the lower portion of the septum on 
both sides, and on the left side it was also very sensi- 
tive along its upper portion. 

" Treatment. — The sensitive turbinated tissue was 
cauterized sufficiently to destroy the hyperesthesia 
and to obliterate the enlarged vessels which the fre- 
quent, sudden and great swelling of this tissue indi- 
cated to be the case. A very small point was used, 
so as to give the least amount of pain. The sensitfW 
organs of the septum were also touched with the cau- 
tery-point. Afterward local treatment was continued 
to the passages for three or four weeks, until the 
parts had healed and no symptoms of hay-fever could 
be excited in any portion of the nasal cavity. 

"He was travelling most of the time, and during the 
latter part of August went West. In November I 
heard from him that he had escaped entirely his 
annual attack, although he was in the region where 
others were having it and where he had had it 
before." 



142 Dr. Logan's Paper. 

Pruritic Khinitis by P, W. Logan, M. D., President 
or the American Ehinological Associa- 
tion, etc. 

Knowing that Dr. P. W. Logan of Knoxville, 
Tenn. has had quite a number of patients (I call fif- 
teen or twenty quite a number) affected with pru- 
ritic rhinitis under his care during the last three years. 
I wrote to him asking his views, experience, etc. 
It is seen that he corroborates what I have given in 
this work. The following is his reply received May, 
22, 1885 : 

Dr. Eumbold. — In response to your letter asking 
for a report of my hay-fever cases, I must say that 
my experience in the treatment of this complaint has 
not been extensive. So far as I am able to judge how- 
ever, I believe that hay-fever is mainly due to a pecu- 
liar excitement of the nerves of the parts which is 
liable to manifest itself by the symptoms known as 
hay-fever, June catarrh, rose catarrh, peach cold, sum- 
mer catarrh, autumnal catarrh, pruritic rhinitis, pru- 
ritic catarrh, etc. 

It is singular that this affection should manifest itself 
in some instances with a periodicity so marked and 
precise, as to appear on the same day of a certain 
month each year; especially when it is known that 
pollen may not appear exactly at the same time every 
year. Our seasons being sometimes early and at 
other times late. 

As pertaines to the various and numerous exciting 
causes, dwelt upon by several authors, I wish to speak 
more especially of pre-existing nasal disease, as an 
important factor in the development of this com- 



Dr. Logan's Paper. 143 

plaint. I refer to chronic inflammation of the nasal 
mucous membrane and some of its sequences such as 
thickened turbinated processes, growths* etc. In all 
of the cases of pruritic catarrh examined by me, 
I have found pre existing nasal inflammation, or posi- 
tive evidence of its existence before the development 
of the complaint. Xasal inflammation however, would 
not in my judgement give rise to this complaint except 
in a patient possessed of this peculiar idiosj-ncrasy to 
which the disease is remotely due. 

In some cases occurring during the winter months 
or continuing into winter, I have been unable to as- 
certain any other exciting cause than the presence of 
a catarrhal inflammation. As positive evidence of the 
fact that hay-fever may owe its existence to the pres- 
ence of catarrhal inflammation or growths, relief from 
this inflammation, etc., will in some instances, I am 
sure, bring permanent relief from the usual attacks. 
This seems to me positive evidence of the fact that 
nasal trouble occurring in a subject possessed of a pre- 
disposition to hay-fever is an important exciting 
cause which should not be overlooked in the etiology 
of this disease. 

Like yourself, Daly, Eoe and Hack, I am inclined 
to the opinion that catarrhal inflammation of the 
nasal mucous membrane exists in many if not in all 
hay-fever victims, and in order to cure the ailment, 
we must relieve the nasal trouble by a mild, soothing 
and unirritating application of vaseline and oil of 
eucalyptus or oil of winter-green 3J of former to gtt, v 
of latter, very gently spra}~ed behind the soft palate, 
into the vault of the pharynx aud posterior nares, 
and over the lower pharynx. At the same time re- 
moval of growth in the nasal passages or the thickened 



144 Dr. Logan's Paper. 

and sensitive raucous membrane covering the turbin- 
ated processes is necessary. 

Where it is possible, I have found it best to treat 
the pre-existing nasal disease anterior to the time at 
which hay-fever usually appears. I can recall several 
cases whom I treated for catarrhal trouble during 
the spring months preceeding the time for the usual 
attack, who after taking treatment did not have a 
return. 

The internal administration of quinine and other 
tonics, diuretics and laxative, I have found very bene- 
ficial in connection with local treatment, but have 
failed to get any perceptible beneficial results from 
valerianate of zinc and assafetida so highly spoken of 
by Dr. Mackenzie of London. 

Hay-fever patients certainly need a tonic and sus- 
taining course of treatment, hence the good effects of 
mountain and sea air. I believe that attitude and sea 
air counteract the operation of pollen, thereby reliev- 
ing many cases of this disease, yet there are excep- 
tions to this general rule. While pollen may be, and 
no doubt in prolific in exciting an attack of this mal- 
ady, I do not think it is always due to this cause. I 
have had a few cases who were very easily effected 
by dust of any kind and by light. I treated them 
locally with the following : Vaseline Jj, oil of winter- 
green gtt v. This mixture was applied with the spray 
producers Nos. 4, 5 and 1, to the vault of pharynx,, 
posterior nares and lower pharynx. The use of as- 
tringents in these cases I have found injurious there- 
fore discard them. 

Why the predisposing and exciting causes of this- 
disease should exist in a greater degree in England 
and America than in any other countries, I am at a 
loss to understand, as we take cold everywhere and 



Dr. Logan's Paper. 145 

are exposed to pollen, dust, etc, in France, Germany 
and other countries, where hay-fever is said to exist 
to a very limited extent if at all. While it is said to 
occur less frequently in the Southern than in the 
Northern or Western portion of the United States, 
catarrhal troubles are likewise not so common, nor so 
inveterate, so far as their succesful treatment is con- 
cerned, in the South as in the North. Climate alone 
however is inadequate to cure catarrhal inflammation 
of the upper respiratory tract. As constitutional pre- 
disposition or idiosyncrasy seems necessary to the es- 
tablishment of hay-fever, we can only counteract dev- 
elopment of the same by subduing rhinal inflammation 
and removing other conditions existing in the nasal 
passages, which might give rise to development of 
this disease. Hay-fever patients unless treated, grow 
worse from year to year. The same is true of catarrh- 
al patients generally. 

In making local applications to my hay-fever pa- 
tients I soon learned that they should be treated very 
gently. The spray should be used with as little air as 
possible to produce a spray sufficient to gently cover 
the affected surfaces, and the patient must not be treat- 
ed too often. As the mucous membrane improves, 
applications should be repeated less frequently. 

I have experienced better results, so far as local 
applications are concerned, from vaseline and oil of 
eucalyptus, applied in the form of spray — than from 
any other remedy or combination of remedies. Of 
course I directed my patients to guard against the op- 
eration of everything which might excite or aggravate 
an attack of their trouble. 

P. W.Logan, M. D., Knoxville, Tenn. 



146 Dr. Stucky's Paper. 



Pruritic Catarrh or Hay-Fever. -Its Treatment.* 
By J. A. Stucky, M. D., of Lexington, Ky j Sur- 
geon to St. Joseph's Hospital ; Member of the 
Kentucky State Medical Society ; Vice Presi- 
dent American Ehinological Associa- 
tion, etc. 

As Dr. J. A. Stucky read a paper on this subject 
before the American Bhinological Association in Oc- 
tober, 1884; I wrote to him asking a copy for this 
work which he has kindly sent to me. 

I am sure that every physician who will read it 
through, will be struck with the thoroughness in 
which he handles the subject, and every interested 
reader will thank him for the very valuable infor- 
mation he has given. 

The following is his contribution to the Associa- 
tion : 

In calling your attention to the subject of Pruri- 
tic Catarrh or so-called Hay-Fever, I am not unmind- 
ful of the fact that I am but adding to an already 
over filled list of contributors to the literature of this 
subject. 

The many conflicting theories as to the etiology 
and pathology of this disease, stimulates me to con- 
tribute my mite. Probably no disease of the supe- 



* Eead before the American Ehinological Association, 
Oct., 1SS4. 



Dr. Stucky's Paper. 147 

rior respiratory tract causes more suffering than so- 
called Hay-Fever. I shall not enter into a detailed 
description of the symptoms, etiology or pathology 
of the disease but am led to offer a few suggestions 
as to the treatment, because of results obtained. In 
the beginning, I desire to enter a protest against the 
term u hay-fever" and all other names of a similar 
nature, giving as a reason, that the terms used to de- 
signate the disease in question are meaningless, hence 
not entitled to the respect they now have. You are 
doubtless aware of the fact that I am not alone in 
taking this view, but am simply following in the wake 
of Dr. Thos. F. Eumbold and joining with him in the 
plea for a name more expressive, appropriate and 
descriptive of the disease. 

If the odor of hay, roses, etc., were the only 
known causes of this disease, we would be satisfied 
with the time honored names hay-fever, rose-cold etc., 
because they would indicate its nature. 

In a recent article on this subject, Dr. Eumbold 
says : "If the name indicate that a certain prominent 
fact or feature of a disease is constantly present so 
as to distinguish it from other diseases, when such is 
not the case, then most certainly the misguiding name 
should be discarded j as its retention will be very 
liable to lead to an erroneous diagnosis, and thus a 
case might be excluded from its proper class, and, as 
a consequence, be improperly treated". Dr. G-. M. 
Beard, a leading authority, Admits the substantial 
identity of Autumnal Catarrh and June Cold, etc. 

" The inappropriateness or rather insufficiency of 
the term hay-fever is now quite generally admitted ; 
for even where the predisposition exists, hay of any 
kind, fresh or dried, acts as an exciting cause in but 
a minority of cases, and rarely, if ever, is it the only 



148 Dr. Stucky's Paper. 

irritant that gives rise to the paroxysms." * "Yet the 
phenomena of the disease are alike in all cases 
whether they occur in the Spring, Summer, Fall or 
Winter ."f 

Without discussing this part of the subject at any 
greater length, I accept the name, suggested by Dr. 
Eumbold, as being the most appropriate because most 
descriptive of the disease. 

I quote at length from a recent article by him : 

"Pruritic Bhinitis or Itching Nasal Catarrh, is the 
name selected for this, as yet unexplained, phenome- 
non. This name is descriptive of its most prominent 
characteristics namely: itching, inflammation and flow 
of mucus. The attack is ushered in by an itching of 
the nose and face ; this soon affects the eyes, caus- 
ing intense suffering. The itching sensation in the 
nostrils gives rise to prolonged sneezing, this in turn 
makes the eyes worse; the itching soon reaches the 
soft palate and fauces, and to relieve these parts of 
the same sensation, the tongue is used to rub them. 
As the tickling is not relieved, a rasping cough is 
tried which is so persistently continued that the 
throat soon becomes sore, and, in older sufferers, 
shortness of breathing ensues, and symptoms of 
asthma are developed. * * * 

" Because of the uniformity of this symptom — itch- 
ing — and the fact that it is always accompanied by 
inflammation, the name suggested indicates the first, 
the principle and most prominent symptom, which is 
characteristic of the malady at whatever season of the 
year the victim is attacked, and it is by no means 
misleading". 

* Beard, on Hay-Fever, 1876. 

f .Kumbold. St. Louis Medical and Surgical Journal, 
June, 1884. 



Dr. Stucky'8 Paper. 149 

I have already referred to the numerous causes (?) 
of this disease, which I shall hereafter designate as 
Pruritic Catarrh. 

It matters not what the exciting cause may be, 
whether pollen of hay, parasites — animal or vegeta- 
ble — bacilli, odor of rose, inhalation of dust, or what 
not, the fact I have been able to demonstrate in 
every case I have seen, is this, that the disease is pre- 
ceded by a nasal catarrh, and relief of the catarrh 
was relief of the u hay-fever." In every case exam- 
ined by me, I have found the middle and inferior 
turbinated bone covered with hypertrophied mucous 
membrane; and during a paroxysm, the nasal cavi- 
ties were completely closed by the swollen membrane, 
giving rise to the uncomfortable feeling and frequent- 
ly excruciating pain in the eyes, cheek, frontal re- 
gion, and in a few cases intense pain in the back of 
the head. A brief glance at the anatomy of the parts 
will easily convince us how that by completely clos- 
ing the openings that lead from the antrum of High- 
more, the frontal, sphenoidal and ethmoidal sinuses, as 
well as the lachrymal canals, will give rise to all of 
the symptoms referred to. In addition to closing of 
these cavities, the inflammation extends into them in 
some cases, giving rise to alarming symptoms. 

The membranous lining of these cavities is simi- 
lar to that of the nasal fossae. Whenever the nasal 
mucous membrane is in an active state of inflamma- 
tion, which is attended with a great degree of swel- 
ling, the communication with the cavities mentioned 
must be shut off, and the accumulating fluids press 
against their boundaries, and as the pressure increas- 
es the pain becomes more intense. This pain ceases 
as soon as the imprisoned fluid finds an exit through 
its natural passage. 

In the American Journal of the Medical Sciences, 



150 Dr. Stucky's Paper. 

July, 1883, Dr. Mackenzie, of Baltimore, Md., says: 

" (1.) That in the nose there exists a well defined, 
sensitive area, whose stimulation, either through a 
local pathological process, or through the action of 
an irritant introduced from without, is capable of 
producing an excitation which finds its expression in 
a reflex act, or in a series of reflected phenomena. 

"(2.) That this sensitive area corresponds, in all 
probabilil}^, with that portion of nasal mucous mem- 
brane which covers the turbinated corpora cavernosa. 

"(3.) That reflex cough (or asthma) is produced only 
by stimulation of this area, and is only exceptionally 
evoked when the irritant is applied to other portions 
of the nasal chamber. 

"(4.) That all parts of this area are not equally cap- 
able of generating the reflex act ? the most sensitive spot 
being probably represented by that portion of the 
membrane which clothes the posterior extremity of 
the inferior turbinated body and that of the septum 
immediately opposite. 

"(5,) That the tendency to reflex action varies in- 
different individuals ', and is dependent upon the vary- 
ing degree of excitability of the erectile tissue. In 
some the slightest touch is sufficient to excite it, in 
others chronic hyperemia or hypertrophy of the 
cavernous bodies seems to evoke it by constant irri- 
tation of the reflex centres, as occurs in similar con- 
ditions of other erectile organs, as, for example, the 
clitoris. 

"(6.) That this exaggerated or disordered functional 
activity of the area may possibly throw some light 
on the physiological destiny of the erectile bodies. 
Among other properties which they possess, may 
they not act as sentinels to guard the lower air pas- 



Dr. Stucky's Paper. 151 

sages and pharynx against the entrance of foreign 
bodies, noxious inhalations, and other injurious agents, 
to which thej* might otherwise be exposed?" 

The physiological phenomena referred to by the 
author, are "to be found in the doctrine of correlated 
areas, the reflex taking place through the vaso-dilator 
nerves from the superior cervical ganglion of the 
sympathetic." 

In the beginning of an attack of Pruritic Catarrh 
the first symptom is intense itching of the nose ac- 
companied by sneezing. Gradually the nasal fossae 
fill up, until nasal respiration is entirely prevented. 
When the disease has reached the point of occluding 
the nares, by infiltration and inflammation of the 
Schneiderian membrane, then the frontal and occipital 
ache, with pain in the cheeks, accompanied by alter- 
nate chilliness and heat and a feeling of general dis- 
comfort with loss of appetite, pyrexia and general 
malaise. Frequently do we meet with cases of in- 
flammation of the middle ear that has extended 
through the Eustachian tube, following attacks of 
Pruritic Catarrh. I need not remind you that during 
a paroxysm, the senses of taste, smell and hearing- 
are much impaired, and soon the sufferer becomes 
prostrated. 1 shall not consume any of your valua- 
ble time by giving a description of the symptoms,. 
with the history of the cases I have treated. Will 
only say, that of all the cases I have recorded every 
one presented all or a majority of the prominent, 
symptoms characteristic of the disease. In conclud- 
ing this part of my subject I agree with Dr. Harri- 
son Alien thatthere is ' nothing peculiar to the dis- 
ease, save its sharply defined periodicity, particularly 
l n that phase of it where the periods of recurrence 
happen to coincide with the time of the fruitage of 



152 Dr. Stucky's Paper. 

certain plants, or the gathering of certain crops." 
I now ask your attention to a consideration of the 
method of treatment employed for this class of suf- 
ferers. If, as we have stated, the disease is due to a 
nasal catarrh, and the paroxj-sms — asthmatic — are 
brought on bj an irritant of some kind, then the log- 
ical inference is, get rid of the catarrh and you get 
rid of the sequelae, of which Pruritic Catarrh (hay- 
fever) is the most annoying — for where the soil is in 
a proper condition and seed sown, it sprouts sponta- 
neously. " Remove the cause, and cure the disease." 

During a paroxysm our treatment is palliative only. 
That we can in every case palliate and cut short the 
aggravating symptoms I have no doubt. Experience 
has demonstrated this. The treatment employed by 
me is that used by Dr. Rumbold, with some modifi- 
cations. If a patient presents himself during an at- 
tack I gently apply, by means of the spray, one-half 
drachm of the following mixture. 

fy Acid Carbol #r. j. 

01. Eucalyptol (Saunders) Mij. 

Boric Acid gfrs. xtoxx. 

Glycerine 3j- 

Vaseline 3vij. 

M. 

One-half dram of this mixture is placed in the 
T)Owl of the spray tube, heated and applied, by means 
of compressed air, gently and thoroughly to the entire 
pharyngo-nasal and post nasal cavity. The relief in 
a majority of cases is almost immediate. The spray 
tubes used in this treatment are those invented by 
Dr. Rumbold, and in them we have a perfect instru- 
ment for thoroughly cleansing and medicating the 
entire superior respiratory tract. 

In a few cases it is necessary to omit the eucalyptol 
on account of its stimulating qualities, when this is 



Dr. Stucky's Paper. 153 

necessary I use the same mixture with this excep- 
tion. The properties of boracic acid need no eulo- 
gizing, they are well known, as antiseptic, slightly 
stimulating and soothing. Strong astringents or irri- 
tants of any kind not only do harm in this variety of 
nasal trouble in the acute stage but in all varieties. 
Our treatment should always be soothing, avoiding 
everything that irritates, this applies only to local 
medical treatment and not to the surgical. 

I not only use boracic acid in this form of nasal 
trouble, but in others, principally the atrophic, in 
strength varying from 5 to 30 grs to the ounce, al- 
ways using vaseline as the excipient and applying by 
means of spray. The application of this remedy in 
the manner suggested is made daily for a week, then 
twice a week until the disease is checked and symp- 
toms disappear. Usually after the first or second 
treatment, patients express themselves as being re- 
lieved. This treatment suggested has given me ex- 
cellent results in mild forms of this complaint in 
adults and still better results in treatment of children 
and persons under 25 years of age. The way in 
which the remedies relieve I suppose to be due to the 
fact that they remove, destroy or render inert the 
irritant that is imbedded in the mucous membrane, 
and by their soothing action reduce the inflammation 
and thus relieve the pent up secretions in the sinuses 
and cavities connected with the nasal organ. 

I do not pretend to say what the exciting cause of 
this disease is, what causes it in one will not in 
another. The one fact I desire to emphasize is, the 
primary cause in every case is nasal catarrh. After 
relieving a case of the most prominent and distres- 
sing symptoms, and nasal respiration is thoroughly 
established, the inflammation and infiltration ail gone, 



154 Dr. Stucky's Paper. 

an examination with the rhinoseope (posteriorly) 
will reveal a mass — varying in size from a small 
buck-shot to the size of a hazel nut — of hypertrophied 
tissues over the posterior extremity of the inferior 
or middle turbinated bone, more frequently the for- 
mer. 

The treatmen already suggested, I stated, was palli- 
ative, and I desire now to speak of the radical treat- 
ment, which consists in the removal of the hypertro- 
phied tissue. This is accomplished by means of the 
Jarvis Snare or, more frequently and preferably, by 
chromic acid. In the use of this agent my experi- 
ence coincides with that of Dr. F. Donaldson, of Bal- 
timore, Md., who says. "We have found chromic acid 
a powerful escharotic, not causing pain or hemorr- 
hage and, when cautiously used, perfectly under con- 
trol." 

Its action is that of a prompt solvent of organic 
matter. It rapidly oxidizes and decomposes the tis- 
sues. It loses one half of its oxygen, and is itself 
converted into the inert sesquioxide. It is, at the 
same time, an antiseptic, and disinfectant. It appears,, 
according to Wood and Bache, " to owe its antiseptic 
action to its power of coagulating albumen and all 
protean compounds, in which it has been found to 
exceed all the acids and metallic salts that have been 
tried, being ten times stronger than carbolic acid, fif- 
teen times stronger than nitric acid, and twent}' times 
stronger than bichloride of mercuiy." It gives less 
pain than other caustics. 

It is one of the most powerful destructive agents to 
inferior organic life, greatly exceeding carbolic acid 
in this respect. The method by which we apply the 
chromic acid (paste made by adding just enough wa- 
ter to render it semi-solid) is to first dry the parts 



Dr. Stucky's Paper. 



155 



with absorbent cotton wrapped around a nasal probe, 
this should be done very gently so as to not excite 
sneezing or cause pain? If the drying process causes 
either it should be discontinued. If the application 
is to be made to the posterior extremity of the turbina- 
ted bone, the instrument represented in Fig 7. is used. 
Fig. 7. 




This is a modification of Dr. Andrew Smith's grooved 
catheter for cauterization of nasal mucous membrane 
b} T means of fuming nitric acid. This instrument is 
smaller and much easier introduced, the canula is flat 
and not round. Length of tube 6 J centi.; flat inside; 
probe, extent 2 centi.; length of handle 5^- centi.; cir- 
cum. of tube 1£ centi.; length of probe 9£ centi. 
There is no need for slot on top of tube as represen- 
ted in the drawing. It will be noticed that the probe 
is 3 centi. longer than the tube or canula. 

The probe is passed through the tube and around 
its distal extremity a small piece of absorbent cotton 
is twisted, and on one side (the side on which the ap- 
plication is to be made) the chromic acid paste \$ ap- 
plied; the probe is then withdrawn into the tube; 
the tube is now oiled with vaseline and gently pushed 
into the nasal fossas through the space between the 
lower turbinated bone and the septum until the point 
reaches the hypertrophied mass to be destroyed. 
This can be ascertained by the touch or by posterior 



156 Dr. Stucky's Paper. 

rhinoscopic examination. After reaching this point, 
the tube is steadied by grasping the handle with 
thumb and fore-finger and placing the little finger 
(of same hand) on lip or cheek of patient and with 
the other hand the probe is pushed through the tube, 
then by depressing and elevating, the handle altern- 
ately, the entire mass may be thoroughly touched 
with the cautery. After accomplishing this, the probe 
is again drawn into the tube, and the instrument with- 
drawn. The cavity is now to be sprayed with Dobell's 
or some alkaline solution which relieves any pain 
caused by the application. By the use of this instru- 
ment we can avoid the touching of any part of the 
mucous membrane that we desire, the cautery being 
concealed, our application can be limited or general. 
Where the mucous membrane is hypertrophied and 
pendulous, over the entire inferior turbinated bone, 
the application is made with instrument represented 
in Fig. 8. which is similar to Fig. 7. In this instru- 
Fisr. 8. 



ment the tube is closed at its distal end and has slot 
on side. 

Length of tube 9£ centi.; length of handle 6 centi.; 
circum, of tube l§ centi.; length of slot 4£ mil.; length 
-of probe 9 centi. 

The tube is inserted into the nasal cavity with the 
slot to the side of the hypertrophy, the probe, cov- 
ered with absorbent cotton and the chromic acid, is 



Dr. Stucky's Paper. 157 

then pushed quickly through the tube and the applica- 
tion made to the entire lower surface of the inferior 
turbinated bone. "The affinity of the acid for or- 
ganic matter is such that it acts immediately. There 
is no pain of consequence resulting, and no bleeding. 
After the first application, our view of the remaining 
portion is not obscured by blood." Two or three ap- 
plications is all that is necessary to remove the larg- 
est hypertrophy of mucous membrane that I have 
seen. I never apply the acid oftener than twice a 
week. After destruction of the membrane, it can be 
easily removed with small forceps or with loop of no. 
5 piano wire attached to a probe. The after treat- 
ment consists in making applications on alternate 
days of the boric-acid- vaseline mixture before men- 
tioned. 

In addition to the treatment already suggested, a 
tonic is always given, the one generally employed 
by me, and with most gratifying results, is the Syr. 
of Hypophos. of Lime and Soda with Iron and Strych- 
nia. 

This preparation I have used largely for several 
years, and, as made by Mr. T. B. Wood, of Lexington, 
Ky., it has no equal, that I know of, as a general tonic. 
Each drachm ( teaspoonful ) contains 2 grs. of Hypo- 
phosphite of Lime and 1 gr. of Soda, 1 gr. of Phos- 
phate of Iron and -gVS 1 ** °f strychnia^. A teaspoon- 
ful is given three times^a day. 

For the itching and burning of the eyes, a Sol. of 
boric acid, 10 gr. to ^j, is frequently used. For the 
rasping cough and headache, 5 gr. salicine, 3 gr. 
amnion, mar., i- gr. extr. belladonna, in capsule every 
2 or 3 hours until relieved, has afforded good results. 
Sufferers from this disease are greatly annoyed by 
cold sweaty feet. Bathing the feet in salt water night 



158 Dr. Stucky's Paper. 

and morning, rubbing them dry, and thoroughly apply- 
ing vaseline, soon relieves this. 



Since the preparation of this paper in Oct., 1884, the 
discovery of the magic effects of muriate of cocaine 
has somewhat changed my views of the treatment of 
Pruritic Catarrh. In the past three months I have 
had five cases of the most aggravated variety of this 
disease and have been able to give each one imme- 
diate relief by the use of a 4 per cent. Sol. of cocaine. 
It was applied by means of absorbent cotton wrapped 
around a thin piece of whale bone, about 2 inches 
long, thoroughly saturated with the cocaine, gently 
inserted into the nostril. The first application was 
allowed to remain 8 or 10 minutes, when it was re- 
moved and a similar one made, using fresh cotton 
and cocaine. The second application was allowed to 
remain ten minutes longer. When it was removed and 
the entire lower border of the inferior turbinated bone, 
as well as the posterior surface of the inferior and 
middle turbinated bones, were thoroughly cauterized 
with chromic acid. OrAy one nasal cavity was treated 
the same day. The after treatment has been the 
same. There has been no unpleasant result following 
this treatment, save a slight pain in the upper jaw 
and the eye of the side to which the application was 
made, which came on a few minutes after and lasted 
from a half to one and a half hours. With the use of 
cocaine I feel certain in promising my patients not 
only temporary relief, but destroy the hypertrophied 
tissue, in the acute stage, thus cutting short at once 
the disease. For several days after this operation 
there is a profuse discharge of mucus but no return 
of the annoying hay-fever (?) symptoms, if the offend- 
ing tissue is thoroughly removed. 



Dr. Stucky's Paper. 159 

When this operation is performed during the acute 
stage, I always advise rest of both mind and body 
for several days and make the application of boric- 
acid-vaseline with from 10 to 15 drops of the coca- 
ine solution daily fora week. 

I feel that I can endorse all the good that has 
been said of the local anaesthetic properties of coca- 
ine. In an extended use of it in the nose and throat 
it has, in my hands, accomplished all that could be 
desired and with it we can now accomplish, what — a 
few months ago — would have taken weeks and 
months. 



INDEX. 



A, 

Acetic acid. 129. 

Air of a mouldy room. 98. 

Air pressure in making the 
spray. 112, 114. 

Allen, Dr. H. 151. 

Alleviative treatment. 108 

American Journal of Medi- 
cal Sciences. 119. 

Anger. 123. 

Anode, how applied. 115. 

Anointing the face, neck, etc. 
119. 

Anterior nasal mirrors. 129. 
Anxiety. 98. 
Appendix. 135. 
Applications, local. 109 
Applicator, Dr. Stucky's. 

155, 156, 
Application of the galvano- 

cautery. 130. 
Archives of Laryngology. 

135. 

Article. Dr. Daly's. 135. 
Assafetida. 144. 
Association, American Lar- 

yngologieal. ix 135. 
Association. American Rhi- 

nological. 142, 146. 
Asthma caused by chronic 

catarrh. 47. 

Asthmatics, 72. 



Asthma in various stages. 
101. 

Attacks, dates of. 27. 

Autumnal form. 91, 104, 128. 

Avoid dust, mouldy hay, etc. 



97, 98. 



B- 



Bacilarise. 99. 

Bacteria. Dr. Daly on. 136. 

Bacteria, Dr. Beard on. 28. 

Bald-headed, wigs for. 117. 

Bathing. 123. 

Beard and Rockwell. 115. 

Beard. Dr. G. M. 23, 24. 25, 

26,27, 29,30, 39. 40, 46, 51, 

m, 86, SO, 91, 92, 93, 102. 

147, 148. 
Beard, length of. 118. 
Beer. 123. 

Binz, Prof. Carl. 38. 
Blacklay, Mr. Chas. H. 39 
Blankets. 122. 
Blood-vessels 10 to 40 times 

their normal diameter. 44. 
Blowing sectetion into the 

ears. 127. 
Boils in the nose. 66. 
Boots. 120. 

Boric acid. 152, 153, 157,159. 
Bostock. Dr. J. 26. 32. 33. 



162 



Index. 



Brandy. 123. 
Bright sunlight. 97. 
Bronchial tubes. 71. 
Brooklyn's divine. 78. 
Burning sensation from the 
probe. 129, 133. 



Cap when required. 1L7, 119. 

Carbolic acid. 113, 152. 

Case. Dr. Daly's. 136. 

Case, Dr. Roe's. 140. 

Case 1. 47. 

Case II. a dentist. 49. 

Case III. 50. 

Case IV. 50. 

CaseV* 51. 

Case VI. 52. 

Case VII. enlarged tonsils. 

54. 
Case VIII. stoppage of the 

nostrils and weeping of 

eyes. 55. 
Case IX. running ears. 5G. 
Case X. pruritic catarrh. 57. 
Case XI. bad case. 58. 
Case XII. 8 years old. 59. 
Case XIII. rose-fever. GO. 
Case XIV. 61. 
Case XV. excessive sneez- 
ing. 62. 
Case XVI. diseased antrum 

of Highmore. 80. 
Case XVII. "hot weather 

catarrh. " 81. 
Case XVIII. sore throat etc. 

81. 
Case XIX. sneezing. 81. 
Case XX. itching eyes. 82. 
Case XXL Colds in warm 

days. 83. 
Catarrhus ^Estivus. 32. 



Cathode, how applied. 115. 
Causes of the Paroxysms. 

97. 
Cauterizing, manner of. 130. 
Central galvanism. 115. 
Change of residence, effect 

ofia the various stages. 

101. 

Chilliness. 76. 

Chronic cases. 94. 

Chronic nasal inflammation 
the cause of pruritic ca- 
tarrh. 45 

Chronic nasal catarrh the 
the originating disease. 44, 
46, 47, 143. 

Chromic acid. 129, 132, 133, 
153, 158. 

Cicatrices follow every cau- 
tery. 126. 

Cicatrices have no mucous, 
glands. 126. 

Clothing. 119. 

Cocaine. 129, 130, 132, 133, 
158, 159. 

Commencement of first stage 
uncertain. 79. 

Conclusions. Dr. Daly's. 137. 

Conservative surgery. 124. 

Constipation. 76. 

Constitution of U. S. Hay- 
fever Association. 18. 

Constitutional Symptoms. 
75. 

Constitutional treatment. 
116, 131. 

Continental tour. 95. 

Cotton matress. 122. 

Cough. 71, 73. 

Coughing to be avoided. 129. 

Course of Pruritic Rhinitis. 
78. 

Cure (?)."36. 



Index. 



163 



D- 

Daly, Dr. Wra, H., xi,135, 143. 

Dates of attack, table of, 27. 

Deceptive sensations. 71,88. 

Defective methods of inves- 
tigation. 19, 42. 

Destruction of growths by 
Dr. Daly. 136. 

Diagnosis and Prognosis. 
100. 

Diet. 122. 

Differential table. 101. 

Disappearance dates of. 27. 

Disappearance, time of, in 
various stages. 101. 

Diseased membrane, locat- 
ing it. 139. 

Diuretics. 116,144. 

Donaldson, Dr. F. 154. 

Drawers, cotton and woolen. 
119. 

Dust 97, 99. 

E- 

Earliest form. 85. 

Effects of irritating treat- 
ment. 48, 49. 

Effects of spray relieving. 
114. 

Elastic garters. 121. 

Electrodes. 133. 

Electricity. 115, 116. 

Elliotson, Dr. 33. 

Eruption. 65. 

Eucalyptus oil. Ill, 143, 152. 

Europe, a visit to. 96. 

Eustachian tubes. 45,69. 127, 
151. 

Exercise. 123. 

Exhaustion from heat. 98. 



Extracts from Dr. Daly's 
paper. 135. 

Extravagent modes of ex- 
pression misleading. 78. 

Eyes. 65,84. 

Eyes affection of in various 
stages. 101. 

F- 

Faradic current, 115. 

Fauces. 69. 

Feathers. 122. 

Flannel suits. 119. 

Flashes of heat. 76. 

Flowers. 98. 

Flowers, the effect in various 

stages. 101. 
First or formative stage. 100. 
Forgetfulness. 47, 77, 80. 
Fourth stage or form. 104. 
"Fuzz " on the trees. 81. 

G- 

Galtherise oil. 113. 
Galvano-cautery. 129, 130, 

131. 
Garters. 121. 
Gin. 123. 

Glycerinse. 113, 152. 
Gordon, Mr. W. 33. 
Gream, Dr. 33. 
Gums. 70. 

H- 

Hack. Dr. 143. 
Hair. 117, US. 
Hair matress. 122. 
Handkerchiefs. 123. 
Hats. 119. 



164 



Index. 



liny asthma, Dr. Daly on, 

135. 
Hay, effect of in various 

stages. 101. 
Hay-fever an inappropriate 

name. 25. 
Hay-fever, mime fir-t given 

by Dr. Bostock. 32. 
Hay is not alone the cause of 

attacks. 25. 
Head, protection of, 117. 
Headaches. 85. 
Heart. 74. 

Heat, exhaustion from, 98. 
Helmholtz. 38. 
Hoods. 119. 

" Hot weather catarrh." 81. 
Hygiene and Treatment of 

Chronic Catarrh, x, 108. 
Hygiene, special- 117. 
Hvi eresthetic membrane. 

128. 



I- 



Ice in sleeping room. 121, 
123. 

Identity of all forms. 24. 

Ill temper. 98. 

Illinois State Medical Soci- 
ety, x, 38. 

Important facts. 12G. 

Indigestion. 70. 98. 

Influence of location. 92. 

Iniatory symptoms. 75. 

Inspissated secretion. 127. 

Instruments for making ap- 
plications. 110, 111. 

Introduction. 17. 

Inunction to body and feet. 
120. 

Irregularity of attack. 79. 

Irritating substances. 98. 



Itching always present in all 
forms. 25. 

Itching a prominent symp- 
tom. 22,30, 64,88, 100* 101. 

Itching diagnostic of prur- 
itic catarrh. 102. 

Itching in various stages. 
102. 

J- 

Jarvis. Dr. 132, 151. 

Jarvis\s snare. 128,129,131, 

133. 
July form. 8G, 89, 104, 128. 
June form. 103, 128. 
June-cold. 85, 86, 87. 



K- 



Kennedy's Pinus Candensis. 

113. 
Kind of cases to be operated 

upon. 128. 
Koran z Dr. 35. 



La Forgue Dr. 34. 

Lake Superior. 52, 95, 

Larynx. G9. 

Laxative. 116, 144. 

Leclanehe cells, 115. 

Lips. 70. 

Literature of pruritic rhini- 
tis. 32. 

Loc:il applications. 109. 

Local symptoms. 64. 

Locating diseased mem- 
brane! 129,138. 

Logan. Dr. P. W. xi, 142. 

Lungs. 71. 



Index. 



165 



M- 

Mac Culloch, Dr. 32. 

31 ckenzie. Dr.ofBa thnore. 

15'. 
M rke z'e. Dr. of Lon Ion. 

144. 
31. v : 
31 e !i al Society of the New 

tfork. 138. 
Medic 1 : ment, 10S. 
Mental >n. 76. 77. 

. 127. 
Milk. 122. 
Mirr >r, j h ry ig< aL 133. 

8. 
Mobs Matrr ss. 122. 
Mouth. 70. 
31 n cons m< ml ra n e a vain ■ - 

ble organ. 12-3. 

N- 

Nares, posterior. 133. 

Nasal cat: rrii -u ; ce I as a 

cause o: catarrh. 

41. 

Nasal cavi a 

^Nasai mirrors, anterior. 120. 
Natural life and hereafter if 
permitted. IS. 

Negative pole, how applied. 

115. 
New name suggested. 22. 
Xig .t air. 93. 
Nightcap. 119. 
Nitric acid. 129. 133. 
Nostrils occluded. 70. 
Nux vomica. 33. 

o- 

Objective syrnpiorns. G4. 
Ocean travel. 94. 



Oil Eucalptus. Ill, 143, 144. 
Oil wint -ivreen. 113. 143. 114. 
Oleat !ne. 130. 

Operate. when to. 12>. 

P. 

Pain in the hest. 73. 

P f ih? heart. 74. 

76. 

r . 2S, 98. 

P. ow to lessen. 

I' 1 - 1 infiam- 

- . 44. 

i reflector. 
133 

I cavity. 6S. 

P is. Dr. P. 34. 

. W. i 7. 

Pinna canadensis comp. 113. 

pole, how applied. 
115. 

Potassium bromide. 116. 

Prater. Mr. A- 34. 

Pr •■■■•At n;;mes misleading-. 

Pric 's glycerine. 113. 
Probe, use of. 129,134. 
Prognosis. 105. 
Proliferative inflammation 

painless 20. 46. 
Pruritic catarrh a sequence 

of chronic nasal catarrh. 

4L. 14:3. 
Pruritis PJiinitis Catarrims. 

22, 30. 31. 

Q. 

Quinine as a remedy for 
'•nay-fever." 3S. 

Quinine, how taken. 116. 
Quinine as a tonic. 144. 



166 



InDeX. 



R. 

Ramadge. Dr. 33. 

Relation of Hay Asthma and 

Chronic Nasopharyngeal 

Catarrh by Dr. Daly. 135. 
Renal secretion. 76. 
Retching and vomiting. 72, 

73. 
Rhinology. 17, 124. 
Rio Janeiro. 95. 
Rockwell. 115. 
Roe, Dr. J. O. xi. 129, 138. 

143. 
Room, location of. 121. 
Rose-cold. 50, GO, 85. 
Rnmbold. Dr. 142, 147, 148, 

152. 

S- 

Salter. Dr. H. 34. 

Sander & Son, Sanhurst, Aus- 
tralia. 111. 

Sanity doubted. 77. 

Sear tissue always dry. 126. 

Sear tissue not mucous mem- 
brane. 126. 

Seasons of the year inappro- 
priate names. 26. 

Second form. 103. 

Section of head, showing 
the application of spray 
producers. 111. 

Septum nasi. 12S. 

Shaving. 118. 

Shoes. 120. 

Skin. 64. 

Sleep. 122. 

Sleeping room. 121. 

Slippers. 120. 

Smell obtunded. 68. 

Smith. Dr. A. 155. 

Smith. Dr. VV. A. 37. 



Sneezing caused by chronic 

catarrh. 47. 
Sneezing in all forms. 25. 
Sneezing in various stages. 

Soft palate retractor. 134. 

Speculreof bone. 129. 

Spittoon. 123. 

Spray producers. 110, 111, 
130, 144. 

St. Louis Medical arid Surgi- 
cal Journal. 108. 

St. Louis Medical Society, 38, 
41, 117, 148. 

Stage of non-recognition. 
84. 

Stages, table of differential 
diagnosis of. 101. 

Statement of patients. 46. 

Stucky. Dr. J. A. xi, 129, 132, 
146. 

Stucky's. Dr. applicator, 155, 
156. 

Subjective symptoms. 64. 

Sunlight, effect of. 97. 

Surgical measures. 128. 

Surgical operation, when not 
required. 106. 

Surgical operation when re- 
quired. 107. 

T- 

Terrors in sleep. 77. 

Thickening process of the 
mucous membrane pain- 
less. 45. 

Third stage form. 104. 

Throat, effect of electricity in 
115. 

Throat, spray applied to. 113. 

Time of attack in various 
stages. 101. 



Index. 



167 



Tobacco. 123. 

Tobacco-smoke. 98. 

Tongue. 70. 

Tongue depressor. 110, 133. 

Tonic. 116, 144. 

Tonsils 70. 

Trachea. 71. 

Treatment. 108. 

Treatment, constitutional. 
116. 

Treatment, how made. 112. 

Treatment. Dr. .Roe's. 141. 

Tubal catarrh. 127. 

Turbinated processes re- 
moval of. 128. 

Turbinated processes dark 
red and oedematous. 68. 

Tympanum. 127. 

D- 

United States Hay-Fever As- 
sociation. 18. 
Uvula- 69. 

Y- 

Valerinate of zinc. 144. 
Various stages 101. 

Vaseline, anointing the face, 
etc. 109, 119. 

Vaseline compound, pre- 
scription for, 111 143, 144, 
152. 



Vaseline mixture, how ap- 
plied by the spray pro- 
ducer. 112, 155. 

Vegetable theory. 28. 
Velum. 69, 133. 
Very chronic cases. 94. 
Vests, cotton and wool. 119. 
Voice. 72. 

w. 

Walking. 123. 
Walsh. Dr. 34. 
Warm the instrument and 

the medicament. 112. 
Water, hot. 122. 
Watson, Dr. 34. 
Webster. Daniel. 36. 
Wesseler. Dr. 81. 
Westward. 95. 
Whisky. 123. 
Wigs healthful. 117. 

Wintergreen. oil of. 113, 143, 

144. 
Wood. Mr. T. B. 157. 
Wyman. Dr. M. 23, 24, 26, 

30, 34, 35, 39, 40, 46, 51. 65, 

66, 86, 105. 



Zinc, valerianate. 144. 



